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ioan

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  1. Ο ευεργέτης Μποσμάν «Πετάει χιονόμπαλες όταν χιονίζει, σκοτώνει μύγες όταν κάνει ζέστη. Με άλλα λόγια, αργόσχολος. Και δεν έχει χρόνο για χάσιμο όταν η τηλεόραση δείχνει μπάλα. Είναι ο Ζαν Μαρκ Μποσμάν, ο Βέλγος που άλλαξε το ποδόσφαιρο. Εκείνο όμως του άλλαξε τα ...φώτα. "Κλείνει την τηλεόραση όταν έχει ματς. Είναι πολύ σκληρό γι' αυτόν" θα πει η κυρία Ανζέλ Μποσμάν, η μητέρα του». Γραμμές που γράφονταν σ' αυτήν εδώ τη στήλη τον Δεκέμβριο του 1998 (τίτλος: «Ας πληρώσουν το μποσμανόσημο»). Και σήμερα, Πέμπτη 15 Δεκεμβρίου 2005, συμπληρώνονται δέκα χρόνια από τη δικαίωσή του στο ευρωπαϊκό δικαστήριο, που απελευθέρωνε τις ύστερα απ' αυτόν γενιές επαγγελματιών ποδοσφαιριστών. Αφηνε όμως άνεργο τον ίδιο. Προσφεύγοντας στο ευρωπαϊκό δικαστήριο του Βελγίου, για να πετύχει τη μετεγγραφή του από τη Φ.Κ. Λιέγης στη Δουνκέρκη, ο Βέλγος πρώην ποδοσφαιριστής έφαγε όλη του την περιουσία στους δικηγόρους, τον έδιωξε η γυναίκα του, έκανε πλούσιους τους συναδέλφους, αλλά... δεν πήρε δεκάρα τσακιστή. Και οι συνάδελφοί του; Πού σε είδα, πού σε ξέρω... Κάποιοι στα δύο χρόνια τού έκαναν ένα ματσάκι. Δεν καλύφθηκαν καν τα έξοδα του αγώνα... Ο νόμος που φέρει το όνομά του ελευθέρωσε τους ποδοσφαιριστές. Κυρίως όμως ωφέλησε τις μεγάλες ομάδες και τις πλούσιες λίγκες που έγιναν πλουσιότερες. Οι μικρές ομάδες όμως και οι φτωχές εθνικές καιι τοπικές κατηγορίες έγιναν φτωχότερες. Δεν μπορούν να κρατήσουν ούτε τους νεαρούς τους. Μια οργάνωση αθλητικών δικαιωμάτων που είχε δημιουργηθεί στο Βέλγιο, με την επωνυμία «Μερσί Μποσμάν», καλούσε τότε τους παίκτες Α' κατηγορίας της Ευρώπης που ευεργετήθηκαν να προσφέρουν το πριμ ενός παιχνιδιού, σε ένδειξη αλληλεγγύης, προς τον Μποσμάν. Ωστόσο ούτε φωνή ούτε ακρόαση. «Αν η μετεγγραφή τους απαιτούσε "μποσμανόσημο" θα πλήρωναν πολύ περισσότερα» δήλωνε ο Μπερτράν Γκρασόν, από τους μετρημένους στα δάχτυλα συναδέλφους του που δεν στάθηκαν αγνώμονες. «Δέκα χρόνια μετά τον περίφημο νόμο, που φέρει το όνομα του, ο Μποσμάν είναι ένας πικραμένος άνθρωπος» διαβάζουμε σε χθεσινό άρθρο του Ραφ Κάζερτ (Ασοσιέιτεντ). «Η πεντάχρονη δικαστική του περιπέτεια έληξε νικηφόρα το 1995, επιτρέποντας στους παίκτες να πηγαίνουν ελεύθερα στον σύλλογο τον οποίο επιθυμούν με τη λήξη του συμβολαίου τους. Ο ίδιος έγινε παρίας. Και αναρωτιέται αν κέρδισε κάτι. Αρνήθηκε να δώσει συνεντεύξεις, καθώς συμπληρώνονται δέκα χρόνια από την ιστορική απόφαση του βελγικού δικαστηρίου που τον δικαίωνε». Τι να πει; Τα είπε όλα τότε. Το άκρον άωτον ήταν μάλιστα πως ελεεινολογούσε εαυτόν για τη νίκη του, προφητεύοντας τη σημερινή πραγματικότητα: «Ανησυχώ διότι η ελευθερία διακίνησης των ποδοσφαιριστών απειλεί να καταστρέψει τις εθνικές σχολές ποδοσφαίρου, να αποδυναμώσει την ντόπια παραγωγή παικτών. Φύγαμε από τη μία ακρότητα, τη σκλαβιά, και κινδυνεύουμε να καταλήξουμε στην ακριβώς αντίθετη, την ασυδοσία των πλουσίων». Οπου τω όντι καταλήξαμε... Κ.Ανς ΕΛΕΥΘΕΡΟΤΥΠΙΑ
  2. Δεν βλέπω την ώρα να πάω να το δώ... Πιστεύω πως είναι must να το δεί κανείς και σε κατάλληλη κινηματογραφική αίθουσα... dolby, digital κλπ Ήδη γυρίζει στο emule, μα είναι κρίμα... σε low quality δεν γίνεται απόλαυση, μα μόνο θέαση. Ένα UP για τον NM25 (Keep up the good work mate!)
  3. Kυτταρικά εμφυτεύματα κατά Πάρκινσον Eλπιδοφόρες εξελίξεις που θα επιτρέψουν τη λεπτομερή μελέτη και την εξεύρεση αποτελεσματικής θεραπείας της νόσου Πάρκινσον έρχονται από τις HΠA. Eρευνητές του Iνστιτούτου Σαλκ του Σαν Nτιέγκο ανακοίνωσαν ότι μπόρεσαν να δημιουργήσουν ποντίκια με ανθρώπινο εγκέφαλο... ή μάλλον με μερικούς ανθρώπινους νευρώνες, που θα τους επιτρέψει να μελετήσουν την εμφάνιση και εξέλιξη των νευρολογικών ασθενειών, όπως το Πάρκινσον, υπό ρεαλιστικές συνθήκες, δηλαδή σαν να τις μελετούσαν στον ανθρώπινο εγκέφαλο. Tα ποντίκια με τα ανθρώπινα κύτταρα στον εγκέφαλό τους δημιουργήθηκαν μετά την έγχυση εκατό χιλιάδων ανθρώπινων εμβρυϊκών βλαστοκυττάρων στον εγκέφαλο εμβρύων ποντικών ηλικίας 14 ημερών. Oταν γεννήθηκαν τα τρωκτικά βρέθηκε ότι το 0,1 % των κυττάρων στον εγκέφαλό τους ήταν ανθρώπινα, γεγονός που ήγειρε αντιδράσεις για την ηθική του εγχειρήματος. Tο ποσοστό τους είναι τόσο μικρό -λένε οι επιστήμονες- που ασφαλώς δεν «εξανθρωπίζει» τα πειραματόζωα. Eπίσης, Aμερικανοί ερευνητές υποστηρίζουν ότι η τοποθέτηση κυτταρικού εμφυτεύματος στον εγκέφαλο ανακουφίζει τα βασανιστικά συμπτώματα του Πάρκινσον. Mέχρι σήμερα οι γιατροί ως θεραπευτική αγωγή χορηγούσαν στους αρρώστους το φάρμακο «λεβοντόπα» με μορφή χαπιού. Oμως, το σκεύασμα συχνά καθιστά τους ασθενείς ευάλωτους σε μυϊκούς σπασμούς. Oμάδα επιστημόνων από το Πανεπιστήμιο της Aλαμπάμα διαπίστωσε σε κλινική μελέτη που πραγματοποίησε σε έξι ασθενείς ότι οφθαλμικά κύτταρα τα οποία παράγουν λεβοντόπα μπορούν να εμφυτευθούν με ασφάλεια στον εγκέφαλο των αρρώστων και να τους ανακουφίσουν από τα συμπτώματα της νόσου χωρίς, όμως, να προκαλέσουν παρενέργειες. H μελέτη δημοσιεύεται στο Archives of Neurology. Tα κύτταρα που χρησιμοποιήθηκαν ως μόσχευμα ελήφθησαν από τον επιθηλιακό ιστό του αμφιβληστροειδούς, παράγουν λεβοντόπα και μπορούν να απομονωθούν από τον ιστό του ανθρώπινου ματιού και στη συνέχεια να εμφυτευθούν στον εγκέφαλο. Tα εμφυτεύματα τοποθετήθηκαν σε έξι ασθενείς που βρίσκονταν σε προχωρημένο στάδιο της νόσου Πάρκινσον. Oι ιατροί επανεξέταζαν τους αρρώστους ανά διετία και καταγράφουν την εξέλιξη της υγείας τους ετησίως. Oπως διαπίστωσαν, τα κυτταρικά εμφυτεύματα ήταν καλώς ανεκτά από τον οργανισμό των ασθενών και δεν παρουσίασαν προβλήματα, ενώ βελτίωσαν ακόμα και κατά 48% την κινητικότητά τους χωρίς να τους προκαλέσουν εκουσίως μυϊκούς σπασμούς. H KAΘHMEPINH -------------------------------------------------------------------------------------------- Eye cell implants improve motor symptoms for Parkinson patients CHICAGO ? A preliminary study suggests that implants of cells from the human retina improved motor symptoms in patients with Parkinson disease, and they appear to be safe and well tolerated, according to a report in the December issue of Archives of Neurology, one of the JAMA/Archives journals. Parkinson disease (PD) is a neurodegenerative disorder characterized by tremor, rigidity, postural instability, and slowed ability to start and continue movements. Most patients with PD require therapy with the medication levodopa to control symptoms three to five years after a diagnosis of PD. However, disease progression and long-term oral treatment with levodopa may lead to the development of motor fluctuations and dyskinesias (difficulty or distortion in performing voluntary movements). Human retinal pigment epithelial (RPE) cells produce levodopa and can be isolated from post mortem human eye tissue, grown in culture, and implanted into the brain attached to microcarriers. These implants have ameliorated the motor deficits in animal models of Parkinson disease, according to background information in the article. (The retinal pigment epithelium is the pigment cell layer found in the inner layer of the retina of the eye.) Natividad P. Stover, M.D., of the University of Alabama at Birmingham, and colleagues conducted an open-label pilot study to evaluate the effect of unilateral implantation of human RPE cells attached to gelatin microcarriers. Six patients with advanced Parkinson disease received cell implants, which were inserted into the brain tissue. The researchers performed efficacy evaluations at one and three months after surgery, and then at six, nine, 12, 15, 18 and 24 months. Yearly follow-up visits are ongoing and will continue. "The implants were well tolerated," the authors report. "We observed an average improvement of 48 percent at 12 months after implantation in the Unified Parkinson's Disease Rating Scale motor subscore with the patient in the off state, which was sustained through 24 months." "Improvement was also observed in activities of daily living, quality of life, and motor fluctuations," they continue. "No off-state dyskinesias were observed." "On the basis of the motor improvement and tolerability observed in this open-label study, a randomized, double-blind, placebo-controlled study has been initiated to more objectively test efficacy and continue to assess safety," the authors conclude. ### (Arch Neurol. 2005;62:1833-1837. Available pre-embargo to the media at www.jamamedia.org.) Editor's Note: This study was supported in part by a grant from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., and Titan Pharmaceuticals, Inc., Somerville, N.J. Co-authors Drs. Schweikert and Allen and Mr. Cornfeldt are employees of and own stock or stock options in Titan Pharmaceuticals, Inc. Co-author Dr. Watts is a consultant for Titan Pharmaceuticals, Inc.
  4. Enduring and Endearing, a Patient Moves In By BARRON H. LERNER, M.D. The patient is what doctors quietly call a "train wreck," suffering from failure of all of the body's organ systems. But once people meet her, such dehumanizing language no longer sticks. Her name is Susan. When Susan's troubles began in 2002, she was 49 and healthy except that she lacked a spleen, removed years before. People without spleens are susceptible to infections, and Susan developed a humdinger: a severe pneumococcal blood infection. Within days, she was near death. Her skin had burned off, she was comatose and her kidneys had shut down, mandating chronic hemodialysis. Many patients die from such severe infections, but Susan lived. She woke from her coma six weeks later, to the joy of her husband and their 3-year-old son. But survival with such extensive complications ensures a rocky recovery. And Susan has probably set some sort of record. Her initial hospitalization lasted 16 months, and she has spent the remaining 2 years bouncing in and out of intensive care and rehabilitation units. A medical student trailing Susan could have received an entire education about what can go wrong with the human body. She has had bleeding in her head, seizures, multiple drug-resistant infections, a broken neck and hip, severe damage to her windpipe and several respiratory arrests requiring resuscitation. Susan's condition is so tenuous, one of her doctors explains, that a small infection makes her confused, short of breath and in immediate need of a ventilator. "But the next morning," the doctor said, "she has bounced back yet again." Has Susan ever thought about giving up? Once, she recalled, she said to herself, "I just know I'm slowly dying here." But she was not dying, just depressed. The depression was not nearly as bad as the mania caused by the steroids she takes for her damaged adrenal glands. She has experienced severe paranoia and auditory hallucinations. But when you meet Susan now, what is most noticeable is her even-keeled nature. Her illness has become a sort of career, and she has mastered the art of patienthood. Susan has her doctors' phone numbers on her speed dial and has paged them at all hours. "Everyone has taken time to explain things," Susan said. The key to his wife's success, according to her husband, has been her sense of humor. Susan is a pianist and comes from a family of entertainers. Stressed-out doctors, angry at being called at all hours, he said, find Susan disarming. Intensive care physicians visit her elsewhere in the hospital, something that rarely occurs. There have been a few bad experiences. Once, Susan complained of back pain that, she insisted, was serious. A resident minimized her claim, glibly telling her that, "If you were dying, you could get a CAT scan." Susan was right. She had had heavy bleeding behind her abdominal organs. "Doctors," she explained, "have to understand that when a person is polite and compliant and then insists she is sick, they need to take it seriously." Susan's doctors readily admit they have learned from her. "She has a tenacity to live that is extraordinary," according to one of her physicians. "You think she should be in a major depression, but she's always smiling," another doctor said. Given her constant nausea and dizziness and 20 daily medications, what has kept Susan going? The answer is easy: Her husband and son, who is now 6 and has grown up with a mother who is rarely around. Her vigorous appetite has also helped. And even though Susan is enamored of forbidden salty foods, one of her doctors said, "after what she's been though, you can't criticize it." Most recently, Susan has required three operations to stabilize her vertebrae, which have become dangerously thin. But there is good news, too: she has identified a possible kidney donor through matchingorgans.com, a Web site that finds strangers to donate organs. And, the donor is willing to wait until she improves. What else does Susan wish for? A way to pay her mounting medical bills. With carried-over coverage from a previous job and expensive private insurance, she has been able to cover only some of her costs. Susan also fantasizes about going back to work. But for now, she must limit herself to occasional impromptu performances at the hospital, like the time she played Chopin on the piano in the rehabilitation unit. When she finished, doctors, nurses and the other patients heartily applauded the hunched-over woman with crooked fingers. Very human, indeed.
  5. Από την Κυριακάτικη Ελευθεροτυπία Λέτε να γίνει η Ελλάδα όπως η Νορβηγία?
  6. Ο καφές δεν αυξάνει την πίεση του αίματος Οι αντιοξειδωτικές ουσίες του θεωρούν οι επιστήμονες ότι βοηθούν την καρδιά Mια μελέτη νοσηλευτριών φέρνει καλά νέα για τις γυναίκες που αγαπούν τον καφέ: η κατανάλωση καφέ δεν φαίνεται να προκαλεί μακροπροθέσμως υψηλή πίεση αίματος. Γυναίκες, στην ίδια μελέτη, οι οποίες έπιναν κόλας, φάνηκαν να έχουν μεγαλύτερο κίνδυνο υψηλής πίεσης αίματος. Oι ερευνητές, όμως, επισήμαναν ότι η μελέτη δεν οδηγούσε σε τελικά συμπεράσματα. H καφεΐνη είναι ένα πολύ γνωστό συστατικό και στα δύο ποτά και έχει αποδειχθεί ότι προκαλεί βραχυπρόθεσμες αυξήσεις της πίεσης του αίματος. Aλλά τα άτομα που έπιναν καφέ στη μελέτη δεν είχαν περισσότερες πιθανότητες από άτομα που δεν έπιναν καφέ να αναπτύξουν υψηλή πίεση αίματος στα δώδεκα χρόνια που ακολούθησαν. Προηγούμενα στοιχεία για τον καφέ και για την υπέρταση είναι ανάμικτα, αλλά υπάρχει μια κοινή αντίληψη ότι οι βραχυχρόνιες επιδράσεις του στην πίεση του αίματος σημαίνουν αυξημένο μακροπρόθεσμο κίνδυνο, είπε ο δρ Wolfgang Winkelmayer του Nοσοκομείου Brigham και γυναικών στη Bοστόνη, επικεφαλής συγγραφέας της μελέτης. Yπήρχαν μερικά αποδεικτικά στοιχεία ότι γυναίκες οι οποίες έπιναν ημερησίως τέσσερις ή περισσότερες κούπες κανονικού ή αποκαφεϊνωμένου καφέ είχαν ελαφρώς μικρότερο κίνδυνο να αναπτύξουν υψηλή πίεση του αίματος από γυναίκες οι οποίες έπιναν λίγο ή καθόλου καφέ. Mια πιθανή εξήγηση, είπε ο δρ Winkelmayer, είναι ότι ο καφές έχει πολλές αντιοξειδωτικές ουσίες, οι οποίες θεωρείται ότι βοηθούν στην προστασία της καρδιάς και περιορίζουν κινδύνους για ανάπτυξη καρκίνου. H μελέτη που χρηματοδοτήθηκε από την αμερικανική κυβέρνηση δημοσιεύθηκε στο περιοδικό της Aμερικανικής Iατρικής Eνωσης. H ομάδα του drs Winkelmayer εξέτασε στοιχεία 155.594 κυρίως λευκών νοσηλευτριών μέσης ηλικίας 55 ετών, οι οποίες έλαβαν μέρος σε δύο μακράς διάρκειας μελέτες. Περιοδικώς τις ρωτούσαν για τη διατροφή και την υγεία τους και τις παρακολουθούσαν επί περισσότερο από 12 χρόνια. Yψηλή πίεση αίματος διαγνώστηκε σε 33.000 από αυτές. Oι γυναίκες οι οποίες έπιναν περισσότερες από τρεις κούπες καφέ ημερησίως είχαν 7% έως 12% μικρότερες πιθανότητες να αναπτύξουν υψηλή πίεση αίματος από τις γυναίκες οι οποίες έπιναν λίγο ή καθόλου καφέ. Η Καθημερινή Το επίσημο άρθρο της έρευνας είναι στο The Journal of the American Medical Association Habitual Caffeine Intake and the Risk of Hypertension in Women Wolfgang C. Winkelmayer, MD, ScD; Meir J. Stampfer, MD, DrPH; Walter C. Willett, MD, DrPH; Gary C. Curhan, MD, ScD JAMA. 2005;294:2330-2335. Context Caffeine acutely increases blood pressure, but the association between habitual consumption of caffeinated beverages and incident hypertension is uncertain. Objective To examine the association between caffeine intake and incident hypertension in women. Design, Setting, and Participants Prospective cohort study conducted in the Nurses’ Health Studies (NHSs) I and II of 155 594 US women free from physician-diagnosed hypertension followed up over 12 years (1990-1991 to 2002-2003 questionnaires). Caffeine intake and possible confounders were ascertained from regularly administered questionnaires. We also tested the associations with types of caffeinated beverages. Main Outcome Measure Incident physician-diagnosed hypertension. Results During follow-up, 19 541 incident cases of physician-diagnosed hypertension were reported in NHS I and 13 536 in NHS II. In both cohorts, no linear association between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment (NHS I, P for trend = .29; NHS II, P for trend = .53). Using categorical analysis, an inverse U-shaped association between caffeine consumption and incident hypertension was found. Compared with participants in the lowest quintile of caffeine consumption, those in the third quintile had a 13% and 12% increased risk of hypertension, respectively (95% confidence interval in NHS I, 8%-18%; in NHS II, 6%-18%). When studying individual classes of caffeinated beverages, habitual coffee consumption was not associated with increased risk of hypertension. By contrast, consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola (P for trend <.001). Conclusion No linear association between caffeine consumption and incident hypertension was found. Even though habitual coffee consumption was not associated with an increased risk of hypertension, consumption of sugared or diet cola was associated with it. Further research to elucidate the role of cola beverages in hypertension is warranted. Author Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics (Dr Winkelmayer), Renal Division (Drs Winkelmayer and Curhan), and Channing Laboratory (Drs Stampfer, Willett, and Curhan), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, and Departments of Epidemiology (Drs Stampfer, Willett, and Curhan) and Nutrition (Drs Stampfer and Willett), Harvard School of Public Health, Boston, Mass.
  7. Psychiatry Ponders Whether Extreme Bias Can Be an Illness By Shankar Vedantam The 48-year-old man turned down a job because he feared that a co-worker would be gay. He was upset that gay culture was becoming mainstream and blamed most of his personal, professional and emotional problems on the gay and lesbian movement. These fixations preoccupied him every day. Articles in magazines about gays made him agitated. He confessed that his fears had left him socially isolated and unemployed for years: A recovering alcoholic, the man even avoided 12-step meetings out of fear he might encounter a gay person. "He had a fixed delusion about the world," said Sondra E. Solomon, a psychologist at the University of Vermont who treated the man for two years. "He felt under attack, he felt threatened." Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are disabled by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis. Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses. If it succeeds, it could have huge ramifications on clinical practice, employment disputes and the criminal justice system. Perpetrators of hate crimes could become candidates for treatment, and physicians would become arbiters of how to distinguish "ordinary prejudice" from pathological bias. Several experts said they are unsure whether bias can be pathological. Solomon, for instance, is uncomfortable with the idea. But they agreed that psychiatry has been inattentive to the effects of prejudice on mental health and illness. "Has anyone done a word search for 'racism' in DSM-IV? It doesn't exist," said Carl C. Bell, a Chicago psychiatrist, referring to psychiatry's manual of mental disorders. "Has anyone asked, 'If you have paranoia, do you project your hostility toward other groups?' The answer is 'Hell, no!' " The proposed guidelines that California psychologist Edward Dunbar created describe people whose daily functioning is paralyzed by persistent fears and worries about other groups. The guidelines have not been endorsed by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM); advocates are mostly seeking support for systematic study. Darrel A. Regier, director of research at the psychiatric association, said he supports research into whether pathological bias is a disorder. But he said the jury is out on whether a diagnostic classification would add anything useful, given that clinicians already know about disorders in which people rigidly hold onto false beliefs. "If you are going to put racism into the next edition of DSM, you would have enormous criticism," Regier said. Critics would ask, " 'Are you pathologizing all of life?' You better be prepared to defend that classification." "I think it's absurd," said Sally Satel, a psychiatrist and the author of "PC, M.D.: How Political Correctness Is Corrupting Medicine." Satel said the diagnosis would allow hate-crime perpetrators to evade responsibility by claiming they suffered from a mental illness. "You could use it as a defense." Psychiatrists who advocate a new diagnosis, such as Gary Belkin, deputy chief of psychiatry at New York's Bellevue Hospital, said social norms play a central role in how all psychiatric disorders are defined. Pedophilia is considered a disorder by psychiatrists, Belkin noted, but that does not keep child molesters from being prosecuted. "Psychiatrists who are uneasy with including something like this in the Diagnostic and Statistical Manual need to get used to the fact that the whole manual reflects social context," said Belkin, who is planning to launch a study on pathological bias among patients at his hospital. "That is true of depression on down. Pathological bias is no more or less scientific than major depression." Advocates for the new diagnosis also say most candidates for treatment, such as the man Solomon treated, are not criminals or violent offenders. Rather, they are like the young woman in Los Angeles who thought Jews were diseased and would infect her -- she carried out compulsive cleansing rituals and hit her head to drive away her obsessions. She realized she needed help but was afraid her therapist would be Jewish, said Dunbar, a Los Angeles psychologist who has amassed several case studies and treated several dozen patients for racial paranoia and other forms of what he considers pathological bias. Another patient was a waiter so hostile to black people that he flung plates on the table when he served black patrons and got fired from multiple jobs. A third patient was a Vietnam War veteran who was so fearful of Asians that he avoided social situations where he might meet them, Dunbar said. "When I see someone who won't see a physician because they're Jewish, or who can't sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, 'This is not our problem,' " the psychologist said. "If it's not our problem, whose problem is it?" Opponents say making pathological bias a diagnosis raises the specter of social engineering -- brainwashing individuals who do not fit society's norms. But Dunbar and others say patients with disabling levels of prejudice should be treated for the same reason as are patients with any other disorder: They would feel, live and function better. "They are delusional," said Alvin F. Poussaint, a professor of psychiatry at Harvard Medical School, who has long advocated such a diagnosis. "They imagine people are going to do all kinds of bad things and hurt them, and feel they have to do something to protect themselves. "When they reach that stage, they are very impaired," he said. "They can't work and function; they can't hold a job. They would benefit from treatment of some type, particularly medication." Doctors who treat inmates at the California State Prison outside Sacramento concur: They have diagnosed some forms of racist hatred among inmates and administered antipsychotic drugs. "We treat racism and homophobia as delusional disorders," said Shama Chaiken, who later became a divisional chief psychologist for the California Department of Corrections, at a meeting of the American Psychiatric Association. "Treatment with antipsychotics does work to reduce these prejudices." * * * Amid a profusion of recent studies into the nature of prejudice, researchers have found that biases are very common. Almost everyone harbors what might be termed "ordinary prejudice," the research indicates. Anthony Greenwald, a psychologist at the University of Washington in Seattle, and Mahzarin R. Banaji, a psychologist at Harvard, developed tests for such biases. By measuring the speed with which people make mental associations, the psychologists found that biases affect even those who actively resist them. "When things are more strongly paired in our minds, we can respond to them more quickly," Banaji said. "Large numbers of Americans cannot as swiftly make the association between 'black' and 'good' as they can between 'white' and 'good.' " Similarly, psychologist Margo Monteith at the University of Kentucky in Lexington found that people can have prejudices against groups they know nothing about. She administered a test in which volunteers, under time pressure, had to associate a series of words with either "America" or a fictitious country she called "Marisat." Volunteers more easily associated Marisat with such words as "poison," "death" and "evil," while associating America with "sunrise," "paradise" and "loyal." "A large part of our self-esteem derives from our group membership," Monteith said. "To the extent we can feel better about our group relative to other groups, we can feel good about ourselves. It's likely a built-in mechanism." If biases are so common, many doctors ask, can racism really be a mental illness? "I don't think racism is a mental illness, and that's because 100 percent of people are racist," said Paul J. Fink, a former president of the American Psychiatric Association. "If you have a diagnostic category that fits 100 percent of people, it's not a diagnostic category." But Poussaint said there is a difference between ordinary prejudice and pathological bias -- the same distinction that psychiatrists make between sadness and depression. All people experience sadness, anxiety and fear, but extreme, disabling forms of these emotions are called disorders. While people with ordinary prejudice try very hard to conceal their biases, Solomon said, her homophobic patient had no embarrassment about his attitude toward gays. Dunbar said people with pathological prejudice often lack filtering capabilities. As a result, he said, they face problems at work and home. "Everyone is inculcated with stereotypes and biases with cultural issues, but some individuals not only hold beliefs that are very rigid, but they are part of a psychological problem," Dunbar said. The psychologist said he has helped such patients with talk therapy, which encourages patients to question the basis for their beliefs, and by steering them toward medications such as antipsychotics. The woman with the bias against Jews did not overcome her prejudice, Dunbar said, but she learned to control her fear response in social settings. The patient with hostility against African Americans realized his beliefs were "stupid." Solomon discovered she was most effective dealing with the homophobic man when she was nonjudgmental. When he claimed there were more gays and lesbians than ever before, she presented him with data showing there was no such shift. At those times, she reported in a case study, the patient would say, "I know, I know." He would recognize that he was not being logical, but then get angry and return to the same patterns of obsession. Solomon did not identify the man because of patient confidentiality. Standing in the central yard of the maximum-security California State Prison with inmates exercising around her, Chaiken explained how she distinguished pathological bias from ordinary prejudice: A prisoner who belonged to a gang with racist views might express such views to fit in with his gang, but if he continues "yelling racial slurs, assaulting others when it's clear there is no benefit" after he leaves the gang, the behavior was no longer "adaptive." Prison officials declined to identify inmates who had been treated, or make them available for interviews. Chicago psychiatrist Bell said he has not made up his mind on whether bias can be pathological. But in proposing a research agenda for the next edition of psychiatry's DSM of mental disorders, Bell and researchers from the Mayo Clinic, McGill University, the University of California at Los Angeles and other academic institutions wrote: "Clinical experience informs us that racism may be a manifestation of a delusional process, a consequence of anxiety, or a feature of an individual's personality dynamics." The psychiatrists said their profession has neglected the issue: "One solution would be to encourage research that seeks to delineate the validity and reliability of racism as a symptom and to investigate the possibility of including it in some diagnostic criteria sets in future editions of DSM."
  8. Sharing Friendship, and Then a Donor's Kidneys By JENNIFER STEINHAUER As friendships go, the one sparked at a Brooklyn dialysis center was one Fred D'Amico and Izya Dukorsky could have lived without. "We have absolutely nothing in common," Mr. D'Amico noted bluntly. And there were the facts: One is gregarious, one, not so much. One votes Democratic, the other Republican. One is Catholic, the other Jewish. One spent his working life tied to a desk, one made tools. Mr. D'Amico has a sweet tooth, Mr. Dukorsky gets hankerings for borscht. What they shared was end-stage kidney disease, which they commiserated about during their three-hour dialysis sessions three times a week for the last 15 months. As it turned out, they shared one other constant: Type A blood. They discovered it in the middle of Monday night when they arrived, seven minutes apart at NewYork-Presbyterian/Weill Cornell hospital, where they learned that they would be getting one kidney each from a man who had died in Colorado. The chance that two men who knew each other from a clinic would both be matches for kidneys from the same donor is slim in any event. The chance of two men who know each other from a clinic in New York State actually receiving kidneys from the same donor is just short of impossible - the medical equivalent of say, a player making a full-court shot, blindfolded. With 6,000 patients between Albany and Brooklyn waiting for kidneys at any time, New York has by far the longest kidney transplant waiting list, often 10 years. "It's very rare for both kidneys to be used even in the same region," said Michael J. Goldstein, one of the surgeons involved in the case. By law, an organ that becomes available must be offered to patients in the region where the donor died before being offered to other areas. But no one in the Colorado region was a match. When the men saw each other in the hospital waiting room, each had the same silent worry. "I looked at his face, and I said, 'What are you doing here?' " recalled Mr. D'Amico, 61, in an interview yesterday in a hospital room he is sharing with Mr. Dukorsky, 58, as they recuperate from their operations. "He said, 'I've come for a kidney.' And I thought one of us is going to get this kidney, and one isn't." Mr. Dukorsky added: "I think to myself, 'Maybe somebody goes home.' I think to myself, 'Maybe next time.' " The men were stunned to learn that there were two kidneys, and that each would probably leave with one. Their blood type; their ages, which were close to the donor's; and the fact that neither had been on dialysis for an extended period - improving their chances of a good outcome - all came together in their favor. The story of their short friendship began in the parking lot of the Nephrology Foundation of Brooklyn. "He came to me and asked me to move a little bit my car," said Mr. Dukorsky, the modified Teller to Mr. D'Amico's Penn. "This is how it starts." They compared notes on pain and blood pressure, and swapped data points. They commented on that doctor they both liked, Dr. Young, the intense one. Did they like each other? "Why not?" Mr. Dukorsky said, with something resembling enthusiasm. They dreamed of transplants the way others pine for a new home that they know they will never afford. "Dialysis is the worst experience you can go through," said Mr. D'Amico, a retired clerk for the International Longshoremen's Association. "It's draining. You get depressed." On Monday, after a particularly grueling session for Mr. Dukorsky, a Russian immigrant and former tool-and-die maker, the two men parted ways. "We said, 'See you Wednesday,' " Mr. D'Amico said. Then, at 11 p.m., Mr. D'Amico got a call from the transplant coordinator at the Rogosin Institute, the keeper of the transplant wait list for NewYork-Presbyterian/Weill Cornell. "She told me a man 54 years old had a terrible head trauma and his family decided to donate all his organs. The lady told me to be at Cornell by 1:30 a.m." He had long been packed. He and his wife, Patrina, called a car service and flew into Manhattan. Not far behind on the Franklin D. Roosevelt Drive was Mr. Dukorsky, with his wife, Sonya, who had received the same call a half-hour later. After their stunned greeting, they waited. First, for the kidneys to arrive. Then, for the tests mixing their blood with the donor's, to flag whether a kidney would be rejected by its recipient. Mr. D'Amico's operation was first, then, Mr. Dukorsky's. They said their goodbyes in the hospital room. Doctors refer to two kidneys from the same donor as sisters. Adopting the vernacular, the two call each other kidney brothers, even if they cannot agree which news channel to watch in their room. They are set to go home this weekend, new men. Both cannot wait to play with their grandchildren again, to use the bathroom the way everyone else does, to travel. "I would tell the family of the donor that there are no real words to express the gratitude," Mr. D'Amico said. "They have given me my life back. This is the best Christmas present ever." "Best Hanukkah," Mr. Dukorsky said.
  9. Μα η παραπάνω foto είναι αυτό που νομίζω πως είναι ή κατάλαβα λάθος?
  10. Στον αναπτυγμένο κόσμο, σχεδόν οι πάντες κυκλοφορούν με ένα κινητό - γιατί, λοιπόν, να μην το χρησιμοποιούν για την υγεία τους; O Gary Katz αντιμετωπίζει πρόβλημα με τη χοληστερόλη του. Πριν από μερικά χρόνια είχε απευθυνθεί σε ένα διαιτολόγο, ο οποίος τον είχε βοηθήσει να μειώσει τα επίπεδα της χοληστερόλης του από 286 σε 177. Τον Απρίλιο, όμως, το καθιερωμένο του ετήσιο τσεκ-απ έδειξε ότι είχε ανέβει και πάλι. Ο επιχειρηματίας απευθύνθηκε στον ίδιο διαιτολόγο. Αυτή τη φορά, όμως, ασθενής και σύμβουλος διαθέτουν ένα μυστικό όπλο: το κινητό τηλέφωνο. Ο κ. Katz χρησιμοποιεί την υπηρεσία MyFoodPhone για να φωτογραφίζει μέσω της κάμερας του κινητού του κάθε του γεύμα. Η διαδικασία αυτή είναι πολύ πιο εύκολη από το να καταγράφει κάθε τι που τρώει σε ένα διατροφικό ημερολόγιο, όπως έκανε την προηγούμενη φορά που αντιμετώπισε το ίδιο πρόβλημα. Στο τέλος κάθε εβδομάδας, ο διαιτολόγος τού αποστέλλει μέσω e-mail μια κριτική για τη διατροφή του. «Ποτέ δεν τα πήγα καλά με το διατροφικό ημερολόγιο», εξηγεί ο 44χρονος κ. Katz. «Τώρα, μπορώ να παρακολουθήσω τη διατροφή μου πολύ πιο εύκολα. Το κινητό μου βρίσκεται πάντα μαζί μου· είναι σαν να έχω μια συνείδηση στην τσέπη μου». Η ιδέα της χρήσης του κινητού για παροχή περίθαλψης δεν είναι καινούργια: όταν οι γιατροί συνήθιζαν τις κατ' οίκον επισκέψεις, η ιατρική βοήθεια ήταν θέμα ενός τηλεφωνήματος. «Οι περισσότερες υπηρεσίες παροχής περίθαλψης παρέχονται σήμερα εντός των ιατρικών εγκαταστάσεων», αναφέρει ο Jose Lacal του MotoHealth, ενός προγράμματος τηλε-ιατρικής, που διευθύνεται από τον δεύτερο μεγαλύτερο κατασκευαστή κινητών τηλεφώνων παγκοσμίως, τη Motorola. «Με το κινητό, όμως, μπορείς να πάρεις τις υπηρεσίες μαζί σου». Η λονδρέζικη συμβουλευτική HBS Consulting εκτιμά ότι η παγκόσμια αγορά «τηλε-υγείας» -η χρήση, δηλαδή, των τηλεπικοινωνιών και της πληροφορικής για την παροχή περίθαλψης και σχετικών υπηρεσιών- θα αυξηθεί μέχρι το 2006 από 3,2 δισ. δολάρια που ήταν το 2003 σε 7,7 δισ. δολάρια. Προς το παρόν, οι περισσότερες υπηρεσίες κινητής τηλε-υγείας, όπως η MyFoodPhone, χρησιμοποιούν γα κινητά απλά για να συλλέγουν και να μεταδίδουν δεδομένα. Το επόμενο βήμα είναι να προσθέσουν ειδικούς ιατρικούς αισθητήρες, οι οποίοι θα μπορούν ακόμη και να ενσωματώνονται στην τηλεφωνική συσκευή. Η νοτιοκορεατική LG, για παράδειγμα, διέθεσε στην τοπική αγορά ένα κινητό με ενσωματωμένο μετρητή γλυκόζης για διαβητικούς. Η συσκευή μπορεί να μεταδώσει την ένδειξη σε ένα γιατρό, σε κάποιο συγγενή ή σε έναν υπολογιστή για περαιτέρω ανάλυση. Η αμερικανική Healthpia America σκοπεύει να διαθέσει τη συσκευή στην Αμερική τον ερχόμενο Ιανουάριο. Η Motorola and Partners Telemedicine (τμήμα της Partners HealthCare, μιας ομάδας νοσοκομείων και υπηρεσιών περίθαλψης στη Βοστώνη) έχει δοκιμάσει συσκευές που μπορούν να μεταδώσουν το βάρος, την πίεση και άλλα στοιχεία του ασθενούς. Οι ζυγαριές και τα πιεσόμετρα επικοινωνούν μέσω Bluetooth (μιας τεχνολογίας ραδιοκυμάτων περιορισμένης εμβέλειας) με το κινητό τηλέφωνο, το οποίο στέλνει στη συνέχεια τα στοιχεία σε ένα γιατρό. Η τεχνολογία βρίσκεται στο στάδιο των κλινικών δοκιμών στη Βαρκελώνη και στη Βοστώνη, αναφέρει ο κ. Lacal, ενώ κατά πάσα πιθανότητα το επόμενο έτος θα έχει φτάσει και στην αγορά. Στη Βρετανία, το Institute of Biomedical Engineering στο Imperial College London, η Toumaz Technology και η Oracle, η δεύτερη μεγαλύτερη εταιρεία λογισμικών παγκοσμίως, ανέπτυξαν από κοινού ένα «σύστημα διεισδυτικής παρακολούθησης», του οποίου οι δοκιμές θα ξεκινήσουν το 2006. Ενας μικρός αισθητήρας, που προσκολλάται με τη βοήθεια ενός αυτοκόλλητου, παρακολουθεί τους χτύπους της καρδιάς του ασθενούς και καταγράφει τις ανωμαλίες. Τα στοιχεία του καρδιογραφήματος αποστέλλονται ασύρματα σε ένα κοντινό κινητό τηλέφωνο, το οποίο στη συνέχεια να αναμεταδίδει σε ένα κέντρο παρακολούθησης ή απ' ευθείας σε κάποιο γιατρό. Η κινητή τηλε-υγεία μπορεί να είναι ακόμη πιο απλή, όμως. Η νοτιοαφρικανική SIMPill κατασκευάζει μια μικρή συσκευή που προσκολλάται σε ένα μπουκάλι με φάρμακο και αποστέλλει γραπτό μήνυμα σε ένα κεντρικό υπολογιστή κάθε φορά που αφαιρείται το πώμα. Αν ο υπολογιστής δεν λάβει μήνυμα, αποστέλλει στον ασθενή, στο νοσοκόμο του ή σε κάποιο συγγενή μια υπενθύμιση μέσω γραπτού μηνύματος. Αυτή τη στιγμή, το σύστημα χρησιμοποιείται από περισσότερα από 2.000 άτομα, εξηγεί ο ιδρυτής της SIMPill, David Green, αφού μόλις κυκλοφόρησε στην Αμερική. Πολλοί περιμένουν ότι η τεχνολογία θα γνωρίσει μεγάλη επιτυχία στη Ν. Κορέα και στην Ιαπωνία, όπου οι καταναλωτές είναι γνωστοί για την εμμονή τους με τα κινητά, αλλά θεωρούν ότι δεν θα έχει την ίδια τύχη στην Αμερική, αφού είναι πιθανό να θεωρηθεί ότι αποτελεί παραβίαση των προσωπικών δεδομένων. Ωστόσο, όπως παρατηρεί ο Donald Jones, επικεφαλής της εταιρείας ασύρματης τεχνολογίας Qualcomm του San Diego, τα ενσωματωμένα χαρακτηριστικά ασφαλείας τα καθιστούν πολύ πιο ασφαλή από τους ηλεκτρονικούς υπολογιστές. Ετσι ή αλλιώς, κανείς δεν μπορεί να μεγαλοποιήσει το θέμα της ανάγκης για εργαλεία που θα διευκολύνουν την αντιμετώπιση των χρόνιων νοσημάτων. Σύμφωνα με τα αμερικανικά Centres for Disease Control and Prevention (κέντρα διαχείρισης ελέγχου και πρόληψης νοσημάτων), πάνω από 90 εκατ. Αμερικανοί υποφέρουν από χρόνιες παθήσεις. Σε αυτούς ανήκει το 75% των συνολικών εξόδων των 1,4 τρισ. δολαρίων που διατίθενται ετησίως για περίθαλψη. Συνεπώς, το κινητό τηλέφωνο θα μπορούσε να αποτελέσει ένα χρήσιμο εργαλείο για την καταπολέμηση των χρόνιων νοσημάτων, αλλά και του υπέρογκου ιατρικού κόστους. Ο Joseph Kvedar της Partners Telemedicine, που επιπλέον διδάσκει στην Ιατρική Σχολή του Harvard, προτείνει, για παράδειγμα, να προσφέρουν οι ασφαλιστικές εταιρείες ένα δωρεάν κινητό σε κάθε πελάτη που πηγαίνει για περίπατο κάθε μέρα - κάτι που θα μπορούσε να επιβεβαιωθεί μέσω ενός μετρητή που θα είναι ενσωματωμένος στο κινητό τηλέφωνο. Η επιρροή των κινητών στην περίθαλψη θα μπορούσε να είναι ακόμη πιο σημαντική στον αναπτυσσόμενο κόσμο, όπου τα κινητά είναι κατά πολύ περισσότερα από τους υπολογιστές. «Για την πλειοψηφία του κόσμου», εξηγεί ο κ. Jones, «αυτός είναι ο μόνος υπολογιστής που θα αποκτήσουν ποτέ. Μπορεί να συνδεθεί με το Διαδίκτυο. Και μπορούν να το μεταφέρουν οπουδήποτε». Ετοιμαστείτε, λοιπόν, να υποδεχθείτε το γιατρό στο τσεπάκι σας. από την Καθημερινή
  11. Το κείμενο που ακολουθεί είναι από το THE DIAGNOSIS by IAN McEWAN from THE NEW YORKER, το οποίο στην ουσία προέρχεται από το το βιβλίο Saturday του ίδιου συγγραφέα. Most people at their first consultation take furtive look at the surgeon’s hands in the hop of reassurance. Prospective patients look fo delicacy, sensitivity, steadiness, perhap unblemished pallor. On this basis, Henr Perowne loses a number of cases each year Generally, he knows it’s about to happe before the patient does: the downward glanc repeated, the prepared questions beginning t falter, the overemphatic thanks during th retreat to the door. Other patients don’t lik what they see but are ignorant of their right t go elsewhere; some note the hands but ar placated by the reputation, or don’t give damn; and there are still others who notic nothing, or feel nothing, or are unable t communicate owing to the cognitiv impairment that has brought them in the firs place. Perowne himself is not concerned. Let the defectors go along the corridor or across town. Others will take their place. The sea of neural misery is wide and deep. These hands are steady enough, but they are large. Had he been a proper pianist - he’s dabbled inexpertly - his ten-note span might be of use. They are knobby hands, bulging with bone and sinew at the knuckles, with a thatch of gingerish hair at the base of each finger, the tips of which are flat and broad, like the suckers on a salamander. There’s an immodest length to the thumbs, which curve back, banana style, and even at rest have a double-jointed look, more suited to the circus ring, among the clowns and trapezists. And the hands, like much of the rest of Perowne, are gaily freckled in a motley of orange and brown melanin extending right up to his highest knuckles. To a certain kind of patient, this looks alien, even unwholesome: you might not want such hands, even gloved, tinkering with your brain. This week, he was pushed hard by a flu outbreak among the hospital staff- his operating list was twice the usual length. By means of balancing and doubling, he was able to perform major surgery in one theatre, supervise a senior registrar in another, and perform minor procedures in a third. He has two neurosurgical registrars on his team at present - Sally Madden, who is almost qualified and entirely reliable, and a year-two registrar, Rodney Browne, from Guyana, gifted, hardworking, but still unsure of himself. Perowne’s consultant anesthetist, Jay Strauss, has his own registrar, Gita Syal. For three days, keeping Rodney at his side, Perowne moved between the three suites - the sound of his own clogs on the corridor’s polished floors and the various squeaks and groans of the theatre swing doors sounded like orchestral accompaniments. Friday’s list was typical. While Sally closed up one patient, Perowne went next door to relieve an elderly lady of her trigeminal neuralgia, her tic douloureux. These minor operations can still give him pleasure - he likes to be fast and accurate. He slipped a gloved forefinger into the back of her mouth to feel the route, then, with barely a glance at the image intensifier, slid a long needle through the outside of her cheek, all the way up to the trigeminal ganglion. Jay came in from next door to watch Gita bringing the lady to brief consciousness. An electrical impulse at the needle’s tip caused a tingling in her face, and once she’d drowsily confirmed that the position was correct - Perowne had it right first time - she was put down again while the nerve was "cooked" by radiofrequency thermocoagulation. The delicate trick was to eliminate her pain while leaving her an awareness of light touch - all done in fifteen minutes, three years’ misery, of sharp, stabbing pain, ended. He clipped the neck of a middle-cerebral-artery aneurysm - he’s something of a master in the art - and performed a biopsy for a tumor in the thalamus, a region where it’s not possible to operate. The patient was a twenty-eight-year-old professional tennis player, already suffering acute memory loss. As Perowne drew the needle clear of the depths of the brain, he could see at a glance that the tissue was abnormal. He held out little hope for radio- or chemotherapy. Confirmation came in a verbal report from the lab, and that afternoon he broke the news to the young man’s elderly parents. The culmination of today’s list was the removal of a pilocytic astrocytoma from a fourteen-year-old Nigerian girl who lived in Brixton with her aunt and uncle, a Church of England vicar. The tumor was best reached through the back of the head, by an infratentorial supracerebellar route, with the anesthetized patient in a sitting position. This created special problems for Jay Strauss, for there was a possibility of air entering a vein and causing an embolism. The Nigerian girl’s operation lasted five hours and went well. Andrea was placed in a sitting position. Opening up the back of the head needed great care because of the vessels running close under the bone. Rodney leaned in at Perowne’s side to irrigate the drilling and cauterize the bleeding with the bipolar. Finally it lay exposed, the tentorium - the tent - a pale delicate structure of beauty, like the little whirl of a veiled dancer, where the dura is gathered and parted again. Below it lay the cerebellum. By cutting away carefully, Perowne allowed gravity itself to draw the cerebellum down - no need for retractors - and it was possible to see deep into the region where the pineal lay, with the tumor extending in a vast red mass right in front of it. The astrocytoma was well defined and had only partially infiltrated surrounding tissue. Perowne was able to excise almost all of it without damaging any eloquent region. He allowed Rodney several minutes with the microscope and the sucker, and let him do the closing up. Perowne did the head dressing himself, and when he finally came away from the theatres he wasn’t feeling tired at all. Operating never wearies him - once busy within the enclosed world of his team, the theatre and its ordered procedures, and absorbed by the vivid foreshortening of the operating microscope as he follows a corridor to a desired site, he experiences a superhuman capacity, more like a craving, for work. As for the rest of the week, the two morning clinics made no more demand than usual. He’s too experienced to be touched by the varieties of distress he encounters - his obligation is to be useful. Nor did the ward rounds or the various weekly committees tire him. It was the paperwork on Friday afternoon that brought him down, the backlog of referrals, and responses to referrals, abstracts for two conferences, letters to colleagues and editors, an unfinished peer review, contributions to management initiatives, and government changes to the structure of the Trust, and yet more revisions to teaching practices. There’s to be a new look - there’s always a new look - at the hospital’s Emergency Plan. Simple train crashes are no longer all that are envisaged, and words like "catastrophe", "mass fatalities", "chemical and biological warfare", and "major attack" have recently become bland through repetition. In the past year, he’s become aware of new committees and subcommittees spawning, and lines of command that stretch up and out of the hospital, beyond the medical hierarchies, up through the distant reaches of the Civil Service to the Home Secretary’s office. Perowne dictated monotonously, and long after his secretary went home he sat typing in his overheated box of an office on the hospital’s third floor. What held him back was an unfamiliar lack of fluency. He prides himself on speed and a sleek, wry style. It never needs much forethought - composing and typing are one. Now he was stumbling. And though the professional jargon didn’t desert him - it’s second nature - his prose accumulated awkwardly. Individual words brought to mind unwieldy objects - bicycles, deck chairs, coat hangers - strewn across his path. He composed a sentence in his head, then lost it on the page, or typed himself into a grammatical cul-de-sac and had to sweat his way out. Whether this debility was the cause or the consequence of fatigue he didn’t pause to consider. He was stubborn and he pushed himself to the end. At eight in the evening, he concluded the last in a series of e-mails, and stood up from his desk, where he had been hunched since four. On his way out, he looked in at his patients in the I.C.U. There were no problems, and Andrea was doing fine - she was sleeping and all her signs were good. Less than half an hour later, he came home to an empty house and lay in the bath with a book, content to be talking to no one. With one toe occasionally controlling a fresh input of hot water, he listened to the radio news. The stolid Mr. Blix had been addressing the U.N. again - there was a general impression that he had rather undermined the case for war. Afterward, Henry stretched out on the bed to consider his supper, and remembered nothing more. His wife, Rosalind, must have drawn the covers over him when she came in from work. She would have kissed him. Forty-eight years old, profoundly asleep at nine-thirty on a Friday night - this is modern professional life. συνεχίζεται
  12. 18 μήνες ο γιατρός, ανάπηρος ο ασθενής ΘΕΣΣΑΛΟΝΙΚΗ Φυλάκιση 18 μηνών με τριετή αναστολή επέβαλε χθες το Τριμελές Πλημμελειοδικείο Θεσσαλονίκης σε ορθοπεδικό για ιατρικό λάθος που οδήγησε σε σπαστική τετραπληγία 36χρονο ασθενή. Σύμφωνα με το κατηγορητήριο, ο ορθοπεδικός Θωμάς Αποστόλου χειρούργησε στο Διαβαλκανικό Ιατρικό Κέντρο τον Ιανουάριο του 2002 τον 39χρονο σήμερα Χαράλαμπο Πετμεζά στο ύψος της θωρακικής μοίρας. Η επέμβαση φέρεται ότι έγινε χωρίς την παρουσία νευροχειρουργού που κρίνεται απαραίτητη σε τέτοιες περιπτώσεις, αλλά και δίχως να έχει ενημερωθεί ο ασθενής για τους μετεγχειρητικούς κινδύνους. ΕΛΕΥΘΕΡΟΤΥΠΙΑ - 07/12/2005
  13. Με απλά λόγια, όποιος γίνεται γιατρός στην Ελλάδα, κρίνεται μονάχα σε προπτυχιακό επίπεδο μέσω των Πανελληνίων. Μετά είναι κατηφόρα. Οι καλύτεροι είναι όσοι έρχονται δαγκωτοί με μεταγραφή από καμιά Ρουμανία, Ουγγαρία, Τσεχία ή Βουλγαρία... γιατί βαπτίζονται στο ελληνικό σύστημα, δίχως καν πανελλήνιες. Θέλει όμως μεγάλο βύσμα. Όσοι έρχονται από Ιταλία πρέπουν να υποστούν τη μαλακία κάποιων που έχουν μείνει στα χρόνια της χούντας και των ορυχείων του Βελγίου. Όσοι έρχονται από Αγγλία, Γερμανία, Σουηδία ή υπόλοιπη EU πρέπει να υποστούν το κόμπλεξ των σερβιτόρων τουριστικών περιοχών. Όσοι είναι στις ΗΠΑ, ακόμα και αν προέρχονται από Ελλάδα, θεωρούν τον εαυτό τους υπεράνω όλων, κρίνουν όλους, μα δεν σκέφτονται τις πολλαπλές ταχύτητες της τσέπης, όπως ακριβώς και NHS, medicaid και medicare. Οι από Ρουμανίες, Σερβίες και υπόλοιπες περι τον Δούναβη, είναι οι φτωχοί συγγενείς. Ρε usmeds, αν κρίνουμε όλα, χρησιμοποιώντας υπεραπλουστεύσεις και γενικεύσεις, βγαίνει μιά εικόνα όπως η πάνω. Το πρόβλημα είναι πως όλοι έρχονται/είναι στην Ελλάδα. Ακόμη και αυτοί που φεύγουν για Αγγλίες και Αμερικές, τη θέση στη λίστα δεν τη σβήνουν. Η σιγουριά αρέσει σε όλους. Ακριβώς όπως κάποιους βολεψάκιδες που θέλουν να είναι γιατροί μόνοι τους, σωτήρες της πατρίδας σε πόλεις και χωριά, μα μόλις βλέπουν πως η ιατρική δεν είναι φέουδο, ουρλιάζουν πως ο χώρος είναι κορεσμένος (μα για τα δικά τους παιδιά υπάρχει πάντα θέση). Όποιος πάει έξω, γίνεται πρωταρχικά γιατρός για να ασκήσει ΕΚΕΙ. Όποιος πάει έξω για την ειδικότητα, πάει για να ασκήσει ιατρική πρωταρχικά ΕΚΕΙ. Προκαλώ να πάει να σβήσει το όνομά του από τις λίστες όποιος φεύγει για την ειδικότητα έξω, δίχως να περιμένει να τον φωνάξουν. Προκαλώ να μείνει στη Ρουμανία, Τσεχία, Ουγγαρία, Βουλγαρία κοκ όποιον τελειώνει ιατρική εκεί. Προκαλώ να έρθει έστω και ένας και να παρουσιάσει στοιχεία από τα οποία αποδεικνύεται πως η ιατρική της Ιταλίας είναι του κώλου από τα χρόνια της Χούντας και ύστερα. Προκαλώ να έρθει έστω και ένας και να υποστηρίξει πως για να πάς για ειδικότητα στις ΗΠΑ δεν κοστίζει ένα κάρο λεφτά. Προκαλώ να έρθει έστω και ένας και να υποστηρίξει πως οπουδήποτε αλλού (έξω από την Ελλάδα) η επιλογή για τις ειδικότητες είναι αντικειμενική, δίχως την υποκειμενικότητα της προσωπικής επιλογής του κάθε υπεύθυνου. Επειδή έχω περάσει ιδιαίτερες δυσκολίες (και εξακολουθώ να περνάω) εξοργίζομαι όταν ακούω απολυτότητες που με αφορούν έμμεσα ή άμεσα. Όταν κάποιος δεν έχει επαφή με την πραγματικότητα λέει μετά ό,τι μαλακία περάσει από το κεφάλι του. Για παράδειγμα γιατί δεν μιλάει κανένας για τα χρήματα και τις διάφορες κοινωνικές προελεύσεις που μπορεί να έχει ο καθένας μας? Θα μπορούσα εγώ να έχω τις γνωριμίες ή και απλά την οικονομική ηρεμία πολλών άλλων που βγαίνουν και πετάνε μιά μπούρδα, μόνο και μόνο επειδή αισθάνονται υπό απειλή? Επειδή ο καθένας έχει τη δική του ιστορία, πρέπον θα ήταν να σταματήσουν οι προσβλητικές γενικεύσεις. Τέλος, επιστρέφοντας στο topic, ο πάνω καθηγητής, είναι πολιτικός και όχι μόνο ακαδημαϊκός. Για το λόγο αυτό η ντροπή είναι διπλή. Δυστυχώς στην Ελλάδα (όπως και στην Ιταλία) θέλουν αξιοκρατικές διαδικασίες, για τα μάτια του κόσμου μόνο. Δύο μέτρα και δύο σταθμά, τα οποία είναι καλά, όταν είμαστε από τους ευνοημένους. Μάλιστα να προσθέσω πως οι περισσότεροι που το παίζουν τσιφλικάδες της ιατρικής, το κάνουν με χρήματα του κράτους, σε δημόσια νοσοκομεία και πανεπιστήμια (όπως και πάρα πολλοί πολιτικοί). Μα είναι εύκολο να είναι κανείς πούστης με τον κώλο του άλλου.
  14. Σκέψου όμως πόσο θα ήταν πρωτοπόρος, αν ερχόταν να γράψει εδώ! Γιατί, όσο κι αν ανεπίσημο ένα απλό forum στο internet, ίσως να το διαβάζουν και κάποιοι καθηγητές... όσοι τουλάχιστον χρησιμοποιούν το internet... ή οι βοηθοί τους.
  15. Υπολόγισε και τα χρήματα για την επέκταση μνήμης
  16. Μα είναι δυνατόν κάθε λίγο και λιγάκι να λέγονται τα ίδια πράγματα? Είναι πάρα πολύ κουραστικό... Λοιπόν, όποιος επαναλαμβάνει τα ίδια και τα ίδια περί πανελληνίων και step 1, step 2 κοκ, ας κάνει ένα search στο forum. Δεν υπάρχει κάτι που να μην έχει ήδη αναφερθεί. Είναι πραγματικά πολύ κουραστικό να λέγονται τα ίδια συνέχεια. By the way... o καθηγητής έχει χρόνο μεταξύ ευρωπαϊκών υποχρεώσεων και πανεπιστημίου να γράψει δύο γραμμές εδώ? Θα έλυνε κάθε πρόβλημα, με πρωτότυπο τρόπο μάλιστα.
  17. Welcome to my hell!!! Ξέρεις πόσες φορές έχω φάει στα μούτρα (και τρώω) τη λογική των δύο μέτρων και δύο σταθμών? Γιατί καλά να είσαι από τη μεριά του ευνοημένου... αν είσαι στην άλλη πλευρά, σου έρχεται να βάλεις τα κλάματα. Τόσο ανήμπορος είναι κανείς... Το τελευταίο πρίν 4 βδομάδες. Τί μπορείς να πείς όμως? Βγάζεις σκασμό και υπομένεις, προσπαθώντας να διατηρείς μιά ψυχική ισορροπία. Γιατί ο μεγαλύτερος κίνδυνος είναι να γίνεις όπως αυτοί που εφαρμόζουν τα δύο μέτρα και δύο σταθμά, βγάζοντας τα αποθημένα εκεί που δεν πρέπει, δίχως ίχνος μετριοπάθειας και σεβασμού.
  18. Illness as More Than Metaphor By DAVID RIEFF My mother, Susan Sontag, lived almost her entire 71 years believing that she was a person who would beat the odds. Even during the last nine months of her life, after she was discovered to have myelodysplastic syndrome, or M.D.S., a particularly virulent blood cancer, she continued to persevere in the belief that she would be the exception. M.D.S. is technically a precursor to acute myeloid leukemia. On average, its survival rates across the generational cohorts are no better than 20 percent, and far worse for a woman in her early 70's who had had cancer twice before. It wasn't that she didn't know that the biological deck was stacked against her; as someone who prided herself on her ability to grasp medical facts, she knew it only too well. In the immediate aftermath of her diagnosis, she went online to learn all she could about M.D.S. and despaired as the fact of its lethality sank in. But that despair was almost the flip side of a lifelong confidence in her ability to defy the odds. "This time, for the first time," she told me, "I don't feel special." Remarkably, in only a few weeks she had righted herself psychologically and was gearing up, just as she had done during her successful fights to survive two previous cancers, to find the doctors and the treatments that seemed to offer her some hope of defying those terrifyingly long odds and once more becoming the exception. How she did this, I don't know. Perhaps it was the spirit that had led her, when she recovered from her first cancer, to write a little proudly in her book "AIDS and Its Metaphors" of "confounding my doctors' pessimism." Perhaps she was able, somehow, to confound her own as well. What I do know is that the panic attacks that had overwhelmed her after her diagnosis began to lessen, and in the M.D.S. literature that she found on the Web she began to find reasons for hope rather than despair. She even began to work again, writing a fiery piece on the Abu Ghraib torture photographs for this magazine at the same time she was readying herself to become a patient at the Fred Hutchinson Cancer Research Center in Seattle, where the bone-marrow transplant that was her only realistic hope of cure had been pioneered. Her "positive denial," as I always thought of it, whether with regard to her health, her work as a writer or her private life, had not been extinguished by the hard facts of M.D.S. after all. On her 70th birthday, 15 months before she found out she was ill again, she talked to me at length and with the characteristic passion she brought to her work about how she was only now starting a new and, she thought, the best phase of her writing life. Leaving for Seattle, she began speaking again of projects she would undertake - above all the novel she had been outlining - after her return to New York and even to speculate about whether she would feel strong enough to write during her treatment. Was it bravado? Doubtless it was, but not bravado alone. During the two years of chemotherapy she underwent in the mid-1970's to treat her first cancer - Stage 4 breast cancer that had spread into 31 of her lymph nodes - she managed to publish a book on photography and, a year later, her book "Illness as Metaphor." That time, she had beaten the odds. William Cahan, then her principal doctor at Memorial Sloan-Kettering Cancer Center in New York, told me at the time that he saw virtually no hope. (Those were the days when doctors often told patients' relatives things they did not disclose to the patients themselves.) But as her friend Dr. Jerome Groopman, chief of experimental medicine at the Beth Israel Deaconess Medical Center in Boston, told me a few months after her death: "The statistics only get you so far. There are always people at the tail of the curve. They survive, miraculously, like your mother with breast cancer. Her prognosis was horrific. She said: 'No, I'm too young and stubborn. I want to go for it"' - meaning treatment. "Statistically, she should have died. But she didn't. She was at the tail of that curve." "We tell ourselves stories in order to live." The line is Joan Didion's, and looking back on my mother's life, I've been wondering lately if we don't tell them to ourselves in order to die as well. In retrospect, I realize that death was never something my mother talked about much. But it was the ghost at the banquet of many of her conversations, expressed particularly in her single-minded focus on her own longevity and, as she got older, by her frequent voicing of the hope of living to be 100. She was no more reconciled to extinction at 71 than she had been at 42. After her death, a theme in many of the extremely generous and heartfelt letters of condolence I received from her friends puzzled me: it was surprise - surprise that my mother hadn't beaten M.D.S. as she had beaten both breast cancer and the uterine sarcoma that struck her in her mid-60's. But then, she, too, was surprised when the doctors in Seattle came in to tell her the bone-marrow transplant had failed and her leukemia was back. She screamed out, "But this means I'm going to die!" I will never forget that scream, or think of it without wanting to cry out myself. And yet, even that terrible morning, in a pristine room at the University of Washington Medical Center, with its incongruously beautiful view of Lake Union and Mount Rainier in the background, I remember being surprised by her surprise. I suppose I shouldn't have been. There are those who can reconcile themselves to death and those who can't. Increasingly, I've come to think that it is one of the most important ways the world divides up. Anecdotally, after all those hours I spent in doctors' outer offices and in hospital lobbies, cafeterias and family rooms, my sense is that the loved ones of desperately ill people divide the same way. For doctors, understanding and figuring out how to respond to an individual patient's perspective - continue to fight for life when chances of survival are slim, or acquiesce and try to make the best of whatever time remains? - can be almost as grave a responsibility as the more scientific challenge of treating disease. In trying to come to terms with my mother's death, I wanted to understand the work of the oncologists who treated her and what treating her meant to them, both humanly and scientifically. What chance was there really of translating a patient's hope for survival into the reality of a cure? One common thread in what they told me was that interpreting a patient's wishes is as much art as science. Dr. Stephen Nimer, my mother's principal doctor, heads the division of hematologic oncology at Memorial Sloan-Kettering and is also one of America's foremost researchers in the fundamental biology of leukemia. As he explained it to me: "The fact is that people are never as educated as the doctor. You have to figure out something about the patient" - by which he meant something that takes both patient and physician beyond the profound, frustrating and often infantilizing asymmetry between the patient's ability to comprehend the choices to be made and the doctor's. Still, the doctor's task here is not impossible. As Nimer put it: "There are risk takers and risk-averse. There are those who say, you know: 'I'm 70 years old. If I get another four or five months, that would be fine.' Others say, 'You do everything you can to save my life.' Then it's easy. You can go straight into a discussion of what a patient wants." For Nimer, as for Jerome Groopman, the ethical challenge, vital for a doctor to recognize and impossible (and ethically undesirable) to deal with formulaically, comes not with the 30 percent of patients Nimer estimates know for certain whether they want aggressive treatment or not, but with the "undecided" 70 percent in the middle. As Nimer told me somewhat ruefully, the doctor's power to influence these patients, one way or the other, is virtually complete. "There are ways to say things," he said. "'This is your only hope.' Or you could say, 'Some doctors will say it's your only hope, but it has a 20 times better chance of harming you than helping you.' So I'm pretty confident I can persuade people." Groopman, in his clinical practice with patients like my mother, patients for whom, statistically, the prognosis is terrible, at times begins by saying, "There is a very small chance, but it comes with tremendous cost." In these situations, doctors like Groopman and Nimer see their job as, in effect, parsing the patient's response and trying to determine a treatment plan that is responsive to the patient's wishes but is also not what physicians refer to as "medically futile" - that is, offering no real chance for cure or remission. That is hard enough. What makes the doctor's decision in such situations even more painful is that "medically futile" means different things to different physicians. After my mother's transplant failed and she was medevacked from the University of Washington hospital back to Memorial Sloan-Kettering, Nimer tried one last treatment - an experimental drug called Zarnestra that had induced remission in some 10 percent of the small number of patients to whom it had been administered. I would learn from the nurses' aides who attended my mother in the last weeks of her life that some of the doctors and nurses on the transplant floor were uncomfortable with the decision, precisely because they saw my mother's situation as hopeless, that is, medically futile. As division head, in consultation with Dr. Marcel van ## no greeklish please! ## - ## no greeklish please! ## - ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - fragolevantika grapste kalytera ## no greeklish please! ## - ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - fragolevantika grapste kalytera ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - agglika - agglika - fragolevantika grapste kalytera ## no greeklish please! ## - ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - fragolevantika grapste kalytera ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - agglika - agglika - Brink, the hospital's chief of bone-marrow transplantation, Nimer could overrule these objections. But neither man would have denied the difficulty of drawing a clear line between what is and is not medically futile. My mother was determined to try to live no matter how terrible her suffering. Her choices had been stark from the outset. Unlike some other cancers that can be halted for years through treatment, there are few long-lasting remissions in M.D.S. Her only real chance of survival lay in the possibility of an outright cure offered by an adult-blood-stem-cell transplant. Otherwise, to quote from one of the medical Web sites my mother visited repeatedly during the first weeks after her diagnosis, treatment offered her only an "alleviation of symptoms, reduction in transfusion requirements and improvement of quality of life." During their second meeting, Nimer offered her the option of treatment with a drug called 5-azacitidine, which gave many M.D.S. patients some months during which they felt relatively well. But the drug did little to prolong life. My mother replied, with tremendous passion, "I am not interested in quality of life!" What Nimer knew with the horrified intimacy of long clinical practice, but what my mother could not yet know, was just how agonizing the effects of an unsuccessful stem-cell transplant can be: everything from painful skin rashes to inordinately severe diarrhea to hallucinations and delirium. To me, torture is not too strong or hyperbolic a word. After my mother's declaration, Nimer only nodded and began talking about where the best place might be for her to have the stem-cell transplant, going over with her the variations in different medical research centers' approaches to transplantation. After the transplant failed, and my mother returned from Seattle, Nimer obviously knew how long the odds were against an experimental drug like Zarnestra inducing even a brief extension of her life. But he said he felt that he had to try, both because the drug had had some success and because my mother had told him (and me) from the outset that she wanted her doctors to do everything possible, no matter how much of a long shot it was, to save or prolong her life. "Always assuming it's not medically futile," he told me a few weeks before her death, "if I can carry out my patients' wishes, I want to do that." My mother could express herself only with the greatest of difficulty in the last weeks of her life. "Protective hibernation" was how one Sloan-Kettering psychiatrist described it. Like most people who have lost someone dear to them, I would say that one of my dominant emotions since my mother's death has been guilt - guilt over what I did and failed to do. But I do not regret trying to get her to swallow those Zarnestra pills even when her death was near, for I haven't the slightest doubt that had she been able to make her wishes known, my mother would have said she wanted to fight for her life to the very end. But this does nothing to change the fact that it seems almost impossible to develop a satisfactory definition of what is and is not medically futile. What is the cutoff? A 10 percent chance of success? Five percent? One percent? When does the "very small chance" my mother's doctors bought at the "tremendous cost" in suffering that Groopman described for me become so infinitesimal as to make it no longer worth trying? I have found no consensus among the oncologists I have spoken with in the aftermath of my mother's death, and I don't believe there is one. There are those who take a strong, consistent stance against not just such treatments but also against the general orientation of American medicine, particularly oncology, toward doing everything possible to save individual patients, no matter how poor their chances. These doctors seem inspired by a public-health model based on better health outcomes for communities rather than individuals, viewing it as the most moral and the only cost-effective way of practicing medicine. This view, often associated with the work of the medical ethicist Daniel Callahan, is increasingly influential. One reason for this is that the current American medical system is breaking down. Several physicians with little sympathy for Callahan's approach pointed out to me that, like it or not, American society either can't afford or no longer chooses to afford to underwrite the kind of heroic care people like my mother, whose prognoses are obviously poor, still receive in the United States. Dr. Diane E. Meier, a palliative-medicine specialist at Mount Sinai Hospital in New York, remarked that if we as a society spent the sort of money on medical care that we spend, say, on the military, the challenge facing physicians would be very different. But neither Meier nor any other doctor I spoke to seemed to believe that there is much chance of that. If anything, medical financing has moved and is likely to continue to move entirely in the opposite direction. As Meier put it to me, "The cost crisis facing Medicare will lead to substantial and real reductions in access to care." One illustration of Meier's point is that Memorial Sloan-Kettering already treats, through funds received from private philanthropists, many patients whose treatment is not covered by Medicare or who have had their applications for treatment at major cancer centers refused by their insurance companies. But it is one of only a few cancer centers in a position to do so. (Even more sobering is the statistic that only a small percentage of Americans with cancer are treated in a cancer center.) Philanthropy aside - and even the most generous philanthropy can never make up the shortfall the continuing cuts in federal financing are likely to produce - it may well be, as Meier suggests, that we are rapidly moving toward a health care system in which "only the rich will be able to choose the treatment they want." In a sense, the financial background of my mother's treatment prefigured the world Meier was describing. Once she and Nimer agreed that she would have a bone-marrow transplant at the Hutchinson Center, and she was accepted as a patient there, she applied to Medicare - her primary insurance - for coverage of the treatment. Medicare refused, saying that coverage could begin only once her M.D.S. had "converted" to full-blown leukemia; in other words, when she was far sicker. My mother then applied to her private insurance company. The response was that her coverage did not extend to organ transplants, which was what it considered a bone-marrow transplant to be. Later, my mother's insurance company relented but still refused to allow her to go "out of network" to the Hutchinson Center, even though Nimer was convinced that the doctors there stood the best chance of saving her life. Instead, the insurer proposed four "in network" options - hospitals where it would pay for the transplant to be done. But three out of the four said they would not take a patient like my mother (because of her age and medical history). The fourth did agree to take her but admitted, frankly, that it had little experience with patients of her age. My mother was determined to get the best treatment possible, and Nimer had told her that treatment was to be found in Seattle. So she persevered. She was admitted to the Hutchinson Center as a so-called self-pay patient and had to put down a deposit of $256,000. Even before that, she had to pay $45,000 for the search for a compatible bone-marrow donor. The knowledge that she was getting the best treatment available, both at Sloan-Kettering and at Hutchinson, was a tremendous consolation to my mother. It strengthened her will to fight, her will to live. But of course she was getting that treatment only because she had the money to pay for it. To be sure, as she was doing so, her doctors both in Seattle and New York very generously helped with her appeal of her insurance company's decision - calling and writing letters providing documentation and expert opinions explaining why the only viable treatment option was the one they had recommended. But both she and they knew that whatever hope she had of cure depended on moving rapidly toward the bone-marrow transplant. This would have been impossible had she not had the money to in effect defy her insurer's verdict, even as she was appealing it legally. Let me state the obvious: The number of Americans who can do what she did is a tiny percentage of the population, and while I shall always be thankful beyond words for the treatment she received, and believe that she and her doctors made the right choice, I cannot honestly say that there was anything fair about it. How or whether the realities of the health care system in America today can be reconciled with the fundamental aspiration of science, which is discovery, and the fundamental aspiration of medicine, which is to cure disease, is impossible for me to say. But if the time I have spent in the company of oncologists and researchers convinces me of anything, it is that these aspirations are almost as fundamental in serious doctors as the will to live is in cancer patients. The possibility of discovery, of research, is like a magnet. Marcel van ## no greeklish please! ## - ## no greeklish please! ## - ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - fragolevantika grapste kalytera ## no greeklish please! ## - ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - fragolevantika grapste kalytera ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - agglika - agglika - fragolevantika grapste kalytera ## no greeklish please! ## - ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - fragolevantika grapste kalytera ## no greeklish please&#33; ## - oxi fragolevantika grapste kalytera sta agglika - agglika - agglika - Brink, the Sloan-Kettering bone-marrow chief, who is Dutch, told me that one of the main reasons he is in the United States is that here, unlike in the Netherlands or, he thought, in the other major Western European countries, there is money for his research. For his part, Jerome Groopman emphasized the overwhelming number of foreign researchers in his lab. He described it as "the opposite of outsourcing - it's insourcing." Researchers find inspiration in the example of AIDS research, an almost paradigmatic example of heroic, cost-indifferent medicine. By public-health standards, AIDS has received a big share of the nation's medical resources, in large measure thanks to the tireless campaigning of gay Americans who have had the economic clout and cultural sophistication to make their voices heard by decision-makers in the medical establishment and in government. As Dr. Fred Appelbaum, clinical-research director of the Hutchinson Center, pointed out to me, understanding AIDS and then devising treatments for it at first defied the best efforts of research scientists. And though a cure has not yet been found, effective treatments have been - albeit, extremely expensive ones. If there is a difference between AIDS research and cancer research, it is that while advances in AIDS came relatively quickly, advances in cancer treatment and, indeed, in the fundamental understanding of how cancer works have come far more slowly than many people expected. Periodically since 1971, when President Nixon declared his war on cancer, the sense that the corner is about to be turned takes hold. We appear to be in such a moment today. The National Cancer Institute has recently put forward ambitious benchmarks for progress in cancer research and treatment. As its director, Dr. Andrew von Eschenbach, a respected surgeon and a cancer survivor himself (he is also acting head of the Food and Drug Administration), put it recently: "The caterpillar is about to turn into a butterfly. I have never known more enthusiasm among cancer researchers. It's a pivotal moment." The suffering of cancer, he argued, will be well on its way to being alleviated by 2015. The media have mostly echoed this optimism. It is not unusual to read about the latest "breakthrough" in cancer treatment, both in terms of understanding the basic biological processes involved and with regard to innovative new drug therapies. On the level of research, there is no doubt that significant progress has been made. Dr. Harold Varmus, the Nobel laureate who now heads Memorial Sloan-Kettering, is emphatic on the subject. "Fifty or 60 years ago," he told me, "we didn't know what genes were. Thirty or so years ago we didn't know what cancer genes were. Twenty years ago we didn't know what human cancer genes were. Ten years ago we didn't have any drugs to inhibit any of these guys. It seems to me we've made an awful lot of progress in one person's lifetime." Other research scientists seemed far more pessimistic when I spoke with them. Dr. Lee Hartwell, also a Nobel laureate, is president and director of the Hutchinson Center. He has urged that the focus in cancer treatment shift from drug development to the new disciplines of genomics and, above all, proteomics, the study of human proteins. Though he acknowledged the profound advances in knowledge made over the past two decades, Hartwell emphasized a different question: "How well are we applying our knowledge to the problem? The therapy side of things has been a pretty weak story. There have been advances: we cure most childhood leukemias with chemotherapy, for one thing. But the progress has been surprisingly weak given the huge expenditures that we've made. We're spending over $25 billion a year improving cancer outcomes, if you include the spending of the pharmaceutical companies. So you've got to ask yourself whether this is the right approach." The focus needs to be on "diagnostics rather than therapeutics," Hartwell said. "If you catch a cancer at Stage 1 or 2, almost everybody lives. If you catch it at Stage 3 or 4, almost everybody dies. We know from cervical cancer that by screening you can reduce cancer up to 70 percent. We're just not spending enough of our resources working to find markers for early detection." Some researchers are even more skeptical. Mark Greene, the John Eckman professor of medical science at the University of Pennsylvania and the scientist whose lab did much of the fundamental work on Herceptin, the first important new type of drug specifically designed to target the proteins in the genes that cause cells to become malignant, agrees with Hartwell. The best way to deal with cancer, he told me, is to "treat early, because basic understanding of advanced cancer is almost nonexistent, and people with advanced cancer do little better now than they did 20 years ago." Varmus, who appears to be somewhere in the middle between the optimists and the pessimists, told me that so far the clinical results are mixed. As he put it: "Many cancers are highly treatable. I am optimistic, but I'm not saying, 'Here's when."' The irreducible fact is that failure is the clinical oncologist's constant companion. Each of those who treated my mother seemed to have evolved a strategy for coping with this. Stephen Nimer said: "I'd have to be an idiot to think everything I do works. I mean, where have I been the last 20 years? I'm not afraid to fail." Fred Appelbaum put it still more plainly. "You get victories that help balance the losses," he said. "But the losses are very painful." Appelbaum's almost studied understatement brought home a question that had recurred through the savage months of my mother's illness and also after her death. I kept wondering how the doctors who were treating her with such determination, against all the odds, could possibly stand swimming in this sea of death that they confronted every day, since they did not have the luxury of pretending, at least to themselves, that they didn't know which of their patients were likely to make it and which were not. The question made sense to some. For Nimer, though, it did not. "I prefer 'swimming in a sea of life,"' he said, adding: "I know I'm not going to save everyone, but I don't think of myself as swimming in a sea of death. People who have congestive heart failure, their outcomes are like the worst cancers. People think of it as a cleaner death and cancer as a dirtier death, but that's not the case. I approach things with the question 'What would it be like if I were on the other side?' The first thing is being dependable. I give people a way to always reach me. They're not going to call me frivolously. There's a peace of mind that comes with knowing you can reach a doctor. I think if you have one of these diseases, you know you can die. Before people get to the time of dying, people want to have some hope, some meaning, that there's a chance things can get better." And when they don't, Nimer continued, "whatever happens is going to happen. But how about the ride? How rough will it be? If I were dying, the thing I'd worry about most is how much I'm going to suffer. I've had a lot of people die over the years. One thing is to reassure people, 'Look, I'm going to do whatever is humanly possible so that you don't suffer.' We're all going to die, but I'm going to spend just as much time paying attention to your last days as I do at the beginning." And with my mother, that is exactly what he did in the moment of her death - one of the many, too many, Nimer has seen. With all due respect to him, if that's not swimming in a sea of death.. . . If my mother had imagined herself special, her last illness cruelly exposed the frailty of that conceit. It was merciless in the toll of pain and fear that it exacted. My mother, who feared extinction above all else, was in anguish over its imminence. Shortly before she died, she turned to one of the nurses' aides - a superb woman who cared for her as she would have her own mother - and said, "I'm going to die," and then began to weep. And yet, if her illness was merciless, her death was merciful. About 48 hours before the end, she began to fail, complaining of generalized low-grade pain (possibly indicating that the leukemia was in her bloodstream). Shortly after, she came down with an infection. Given the compromised state of her immune system, the doctors said, there was little chance that her body could stave it off. She remained intermittently lucid for about another day, though her throat was so abraded that she could barely speak audibly and she was confused. I feel she knew I was there, but I am not at all sure. She said she was dying. She asked if she was crazy. By Monday afternoon, she had left us, though she was still alive. Pre-terminal, the doctors call it. It was not that she wasn't there or was unconscious. But she had gone to a place deep within herself, to some last redoubt of her being, at least as I imagine it. What she took in I will never know, but she could no longer make much contact, if, indeed, she even wanted to. I and the others who were at her side left around 11 p.m. and went home to get a few hours' sleep. At 3:30 a.m. on Tuesday, a nurse called. My mother was failing. When we arrived in her room, we found her hooked up to an oxygen machine. Her blood pressure had already dropped into a perilous zone and was dropping steadily, her pulse was weakening and the oxygen level in her blood was dropping. For an hour and a half, my mother seemed to hold her own. Then she began the last step. At 6 a.m., I called Nimer, who came over immediately. He stayed with her throughout her death. And her death was easy, as deaths go, in the sense that she was in little pain and little visible anguish. She simply went. First, she took a deep breath; there was a pause of 40 seconds, such an agonizing, open-ended time if you are watching a human being end; then another deep breath. This went on for no more than a few minutes. Then the pause became permanence, the person ceased to be and Nimer said, "She's gone." A few days after my mother died, Nimer sent me an e-mail message. "I think about Susan all the time," he wrote. And then he added, "We have to do better."
  19. Απ' το ΙΚΑ στο... ΕΣΥ ΔΗΜΗΤΡΑ ΕΥΘΥΜΙΑΔΟΥ Την αξιοποίηση πολυϊατρείων του ΙΚΑ από το ΕΣΥ ώστε να μπορούν να τα χρησιμοποιούν ασθενείς όλων των ταμείων προβλέπει, μεταξύ άλλων, το νομοσχέδιο για τη μεταρρύθμιση στην πρωτοβάθμια υγεία, που αναμένεται να είναι έτοιμο έως το τέλος του χρόνου. Η ηγεσία του υπουργείου Υγείας αφήνει να εννοηθεί πως έχει εξασφαλιστεί η συναίνεση του ΙΚΑ. Ωστόσο, στο παρελθόν, όσοι υπουργοί επιχείρησαν να μπουν στα χωράφια του ιδρύματος (μεταξύ άλλων και ο Αλέκος Παπαδόπουλος) στο τέλος συγκρούστηκαν με τους αρμόδιους του ασφαλιστικού ταμείου. Εγκυρες πηγές αναφέρουν ότι το επιχείρημα που ετέθη στο ΙΚΑ για να παραχωρήσει τις δομές του είναι πως εδώ και χρόνια το ασφαλιστικό ταμείο δεν καταβάλλει στα κέντρα υγείας το ποσό των 3 ευρώ για κάθε ασθενή που τα επισκέπτεται, παρ' ότι το προβλέπει ο νόμος 2519 του 1997. * Σύμφωνα με το νομοσχέδιο, θα δοθούν από το ΙΚΑ προς χρήση από το ΕΣΥ 10 πολυϊατρεία στην Αθήνα, 5 στη Θεσσαλονίκη, 2 στην Πάτρα και από 1 στις υπόλοιπες μεγάλες πόλεις. * Τα πολυϊατρεία θα μετατραπούν σε κέντρα υγείας αστικού τύπου, τα οποία θα μπορούν να επισκέπτονται ασφαλισμένοι όλων των ταμείων, χωρίς προσωπική επιβάρυνση σε αρχικό στάδιο. * Στα ιατρεία αυτά θα συνεχίσουν να εργάζονται οι σημερινοί υπάλληλοι του ΙΚΑ, είναι όμως άγνωστο εάν θα ενταχθούν μισθολογικά στο ΕΣΥ. * Θα ενισχυθούν τα νέα κέντρα υγείας αστικού τύπου με προσωπικό. * Πρόκειται να δημιουργηθεί δίκτυο οικογενειακών γιατρών, στους οποίους πρέπει να απευθύνονται αρχικά οι ασθενείς και στη συνέχεια θα παραπέμπονται στο κέντρο υγείας ή σε νοσοκομείο. * Για την ολοκλήρωση του δικτύου θα απαιτηθούν αρκετά χρόνια, αφού χρειάζονται τουλάχιστον 6.000-7.000 γιατροί για να καλύψουν τις ανάγκες τόσο των κέντρων υγείας αστικού τύπου όσο και των απλών κέντρων υγείας. * Θεωρείται πολύ πιθανό οι ιδιωτικές ασφαλιστικές εταιρείες να πρέπει να καταβάλλουν το κόστος της ιατρικής και εργαστηριακής εξέτασης των ασφαλισμένων τους στα κέντρα υγείας, όπου σήμερα όλοι οι ασθενείς εξετάζονται δωρεάν. Αντίστοιχο μέτρο είναι πιθανό να ληφθεί και για τους αλλοδαπούς. * Φιλοδοξία είναι, εκτός των άλλων, τα κέντρα υγείας αστικού τύπου να διαθέτουν βιοχημικό, ακτινολογικό και μικροβιολογικό εργαστήριο. * Παράλληλα θα υπάγονται οικονομικά και διοικητικά στις Διευθύνσεις Υγειονομικής Περιφέρειας (ΔΥΠΕ), ενώ μέχρι σήμερα τα κέντρα υγείας ανήκαν οικονομικά στα νοσοκομεία, γεγονός που δημιουργούσε πολλά προβλήματα στην προμήθεια εξοπλισμού και υλικού. Ηδη, πιλοτικά, τα κέντρα υγείας στην Κρήτη υπάγονται στις ΔΥΠΕ. * Ο υπουργός Υγείας δέχθηκε πρόταση από τον Μποδοσάκη Μερκούρη, που συμμετέχει στην επιτροπή επεξεργασίας του νομοσχεδίου, να καταβάλλουν ένα συμβολικό ποσό οι πολίτες, ώστε να ενταχθούν στο σύστημα του οικογενειακού γιατρού. Οπως εξηγεί ο κ. Μερκούρης: «Θα έπρεπε όποιος εγγράφεται στη λίστα του οικογενειακού γιατρού να πληρώνει εφάπαξ για παράδειγμα ένα ποσό ύψους 20 ευρώ, ώστε να μπορεί και να κάνει χρήση των κέντρων υγείας αστικού τύπου». Ωστόσο, μέχρι στιγμής η συγκεκριμένη πρόταση δεν φαίνεται να γίνεται αποδεκτή από το υπουργείο Υγείας. ΚΥΡΙΑΚΑΤΙΚΗ ΕΛΕΥΘΕΡΟΤΥΠΙΑ - 04/12/2005
  20. No one should face death alone A dying, and scared, patient wants someone by her side. Doesn't she deserve that? It was just before dawn when I found the 40-year-old woman ? pale, sweaty and anxious ? cradled in bloody sheets and towels. A victim of end-stage cervical cancer whose kidneys were also shutting down, she had recently decided enough was enough. To be specific, she wanted no more radiation, no more transfusions, no dialysis and, above all, no heroic measures if her breathing stopped or her heart slowed to a standstill. The "do not resuscitate" order was duly entered in her hospital chart, alerting medical personnel to forgo life support when the final crisis came. But no one expected the crisis to come so soon. When the new hemorrhage began, no family members were at the patient's bedside. The already short-staffed night nurses were passing medications and caring for other critical patients. The patient's intern, resident and attending doctor were not in the hospital. Which left me ? a fourth-year medical student merely passing by ? with a dilemma. I also had work to do before my long night on call became another grueling day. But this patient was alone and scared. And so I debated: Should I stay with her until others arrived? Whether her death was an hour or a day away was not the point. She was dying, and she wanted someone by her side. Last month, this poignant scene from long ago came back to me as I listened to a lecture at my hospital in a six-week series on pain management and end-of-life issues. Admittedly, I had not taken my plush auditorium seat entirely by choice. Rather, I was fulfilling an obligation. To maintain a medical license, California physicians must complete 12 hours of continuing medical education on these topics by the end of 2006. But once the speaker ? a radiation oncologist and palliative care specialist ? started to talk, she captured my attention. Palliative care, Judith Ford explained, is not just about relieving pain but also easing the loneliness of death. Plus much more. To borrow Ford's words, "We don't just sing 'Kumbaya' and hang morphine drips." Ford only wishes more people took advantage of palliative care services ? physical and psychosocial ? at earlier stages of illness. Ford told the story of another dying woman in her 40s. Her greatest pain stemmed from the fact that none of her children ? including two young adults ? were able to accept her diagnosis of terminal cancer. Instead, they would prop her in a wheelchair, take her to the mall and buy her new clothes and other pretty things, all the while declaring she would soon be well. Not until she confessed her profound loneliness to a palliative care professional did a family meeting produce the support the mother desperately craved. Is it possible that end-of-life isolation ? or abandonment, to use a blunter term ? is more widespread now than ever, despite medical advances? In thinking about this, take a step back in time. During the 19th century, a borning room was the place in many houses where babies entered the world and the sick and elderly exited. As a result, few people were shielded from death. Today, in contrast, roughly 70% of all Americans die in hospitals ? literally, behind closed doors. Yes, hospitals often provide essential services to dying patients, but their very mission ? to sustain life ? can send a hidden message that dying represents failure. At the root of the problem is not hospitals, but people. Me and you. After a "do not resuscitate" order is written, some doctors feel their job is done. The DNR order allows them to drift away, both professionally and emotionally. In other cases, dying patients and their family members, as well as doctors, do not accept the inevitable. It's easy to see why. Modern medicine offers many straws for the desperate to clutch. But some measures get in the way of final goodbyes. Perhaps the time has come for new acronyms. DNAR, or "do not attempt resuscitation," would remind the overly aggressive that medical resuscitations of the very sick and elderly are often futile, thus re-focusing attention on human and spiritual needs at the end of life. An editorial in the popular doctors magazine Medical Economics recently proposed another acronym ? AND, for "allow natural death" ? to convey a similar message. When I remember the bleeding woman with cervical cancer, however, "do not abandon" sums it up for me. In her case, a thoughtful end-of-life decision still went terribly awry. Although I and several others remained with her throughout her last day, her family never did appear. Whether they were called too late by hospital staff or unwilling to come, I never found out. Perhaps the patient herself kept them in the dark. All I know for sure is that she died as few would choose ? deeply lonely. Many people do. As healthcare professionals, patients and family members, we can all do something about it. Claire Panosian Dunavan is an infectious diseases specialist and professor of medicine at the David Geffen School of Medicine at UCLA
  21. Για μένα είναι υπερβολικό να χρησιμοποιείται η διαδικασία της καταγγελίας, όταν γίνεται μιά δημόσια συζήτηση σε forum στο internet. Αν κάποιος ξεφεύγει (κατά τη γνώμη κάποιου άλλου μέλους) από τα όρια της ορθής συμπεριφοράς υπάρχουν συγκεκριμένοι μηχανισμοί προστασίας, μέσω administrators και moderators. Η συζήτηση, εφόσον δημόσια, επιτρέπει μάλιστα σε οποιοδήποτε να απαντήσει. Ο ίδιος ο καθηγητής, αν θέλει, μπορεί να έρθει και να γράψει εδώ στο φόρουμ, διαψεύδοντας τις όποιες φήμες.
  22. Dire Wounds, a New Face, a Glimpse in a Mirror By CRAIG S. SMITH LYON, France, Dec. 2 - The world's first person to wear a new face awoke Monday, 24 hours after her operation in the northern city of Amiens, and looked in the mirror. The swollen nose, lips and chin she saw there were not her own - those had been ripped from her head by her pet Labrador in May - but for the 38-year-old woman, whose face had become a raw, lipless grimace, they were close enough. She took a pen and paper and wrote for the doctors, "Merci." On Friday, those doctors defended their rush to give the woman a partial face transplant just months after her disfigurement, despite the enormous risks of death and psychological difficulties. They dismissed objections that they were bent on glory at the expense of the patient, whose identity is being withheld at her request. "We are doctors," said Jean-Michel Dubernard, who led the transplant team and who helped carry out the first hand transplant in Lyon seven years ago. "We had a patient with a very severe disfigurement that would have been extremely difficult, if not impossible, to repair with classic surgery." In a news conference at ?douard-Herriot Hospital in Lyon, where the patient was transferred for monitoring of immunosuppressive therapy that will continue throughout her life, the doctors explained how the woman's gruesome wounds almost immediately made her a candidate for the world's first face transplant. They heatedly denied local news reports that quoted her estranged teenage daughter as saying she was suicidal, raising questions about whether she was psychologically stable enough for the operation. Dr. Dubernard has faced such accusations before. Clint Hallam, the man he selected for the world's first hand transplant, refused to keep up with the lifelong drug regimen required to suppress immune responses, along with regular exercises to train the new hand. After three years he had the hand removed. According to Dr. Dubernard, the woman had quarreled with her daughter one evening in May at her home in the northern city of Valenciennes, and the daughter had left to spend the night at her grandmother's. The woman was agitated, he said, and took a sleeping pill. At some point during the night, he said, she arose and stumbled through the house, encountering the dog. Local news reports have suggested that the woman, who is divorced, fell unconscious and that the dog chewed and clawed her face in an attempt to revive her. But Dr. Dubernard said the dog had been adopted from the local pound and was known to be aggressive. The dog has since been destroyed. Shortly after the woman's injury, Dr. Bernard Devauchelle, head of face and jaw surgery at Amiens University Hospital, decided that the woman was a candidate for a partial face transplant and sent an urgent request for help in locating a donor to the French Biomedicine Agency, which oversees the allocation of organs for transplant in France. The window for a successful transplant was narrow, the doctors said, because the wound was developing scar tissue. Dr. Beno?t Lengel?, a Belgian surgeon who assisted in the transplant, said the woman would have required at least three or four traditional plastic surgery operations to rebuild her face with skin flaps from other parts of her body, but the results would never have been aesthetically or functionally satisfactory. Meanwhile, the woman's injury had made it difficult for her to talk or even drink and eat, because food and liquid spilled easily from her mouth. The doctors said her ability to open her jaw was also progressively diminishing as her wounded tissue stiffened. In July, Dr. Devauchelle consulted with Dr. Dubernard, who visited the woman in early August. "The moment she removed her mask, which she always wore, I had no more hesitation," Dr. Dubernard said Friday. No information was given about the donor, a brain-dead woman whose anonymity is protected by law. She was located on Saturday at a hospital in the northern city of Lille, 85 miles from Amiens. Brain-dead patients in France are presumed to be organ donors unless they have made explicit provisions to the contrary, and approval by next of kin is not normally required. But given the delicacy of the case, the donor's family was consulted about the possible harvesting of part of the donor's face during the initial interviews that are undertaken to ensure that the deceased had not given instructions preventing organ donations. A special team of psychologists worked with the family on Saturday afternoon as the doctors involved were notified that a potential donor had been found. By midnight Saturday, Dr. Devauchelle, who led the surgical team, was in Lille to begin harvesting the face while another team of surgeons in snowy Amiens began removing scar tissue from the patient in preparation for the transplant. Harvesting of the face was complicated by the convergence of several teams to remove other organs from the donor, but the operation was complete by 5 a.m. Sunday. Before the donor's funeral, a separate team of doctors reconstructed her face with a silicone prosthesis made from a cast taken before the dissection. "The restoration was remarkable," Carine Camby, the director of the French Biomedicine Agency, said of the prosthesis. Dr. Devauchelle rushed to Amiens with the patch of face, chilled in a saline solution to 39 degrees Fahrenheit, and began the transplant, starting with microsurgery to connect the blood vessels feeding the face. Dr. Devauchelle said blood circulation to the transplanted portion was restored at 9 a.m. Sunday, four hours after it had been severed from the donor. The operation continued into Sunday afternoon as a team of eight surgeons connected muscle and nerves "as fine as the fibers hanging from a string bean," Dr. Dubernard said. Finally they sewed up the skin and mucous membranes of the mouth, working 15 hours in all. As they were cleaning the woman's face and preparing bandages, silence fell over the operating room. "The result was beyond our expectation," said Dr. Lengel?, part of the surgical team. "It was marvelous." A nurse asked if they might applaud, and when one of the doctors nodded, the nurses began to clap. By Friday morning, the woman was eating and drinking and speaking clearly, the doctors said. Though she does not yet have muscular control or feeling in the transplanted portion of her face, she is able to open and stretch her mouth with the facial muscles that had remained intact. The doctors said it would be months before they knew how much, if any, feeling or motor control she would have in the graft, though they said the swelling had already begun to recede and her appearance was relatively normal. "There is only a thin scar running around the transplanted area," said Dr. Lengel?, adding that the patient had already showed signs of psychologically accepting the transplant, saying Thursday, "This is my face." The doctors stressed that the appearance was determined as much by the underlying bone structure as by the features of the skin, but added that the donor's skin color, texture and thickness presented a "stunning" match to the recipient's. If the transplant is ultimately successful, they said, the woman will look neither exactly as she did before nor like her donor. "It will be a new face," Dr. Devauchelle said. A patch of tissue taken from the donor's forearm and transplanted under the woman's arm will allow doctors to monitor the body's response to the graft without having to take scarring biopsies from her face. The doctors said the woman had already passed the period when thrombosis, or blood clots, presented the greatest risk to her life, but that the most critical time for a possible rejection of the graft would come in the next week. Dr. Dubernard said he had already injected stem cells from the donor's bone marrow into the patient in an attempt to enhance her body's tolerance of the transplanted tissue. After reviewing successful hand transplants, he theorized that cells produced by the marrow of the donor's hands were the critical element in the operation's success. He added that another "infusion" of the donor's bone marrow stem cells would be given to the patient on the 11th day after the transplant. The transplant did not include bone. As with all transplants, the doctors said, there was about a 33 percent risk of death, a 33 percent risk that the body will reject the graft and only a 33 percent chance that the transplant will prove successful. Surgical teams in other countries, including the United States, are closely watching the outcome before proceeding with face transplants they are planning. "We think of all the people who have been disfigured to whom we could give new hope," Dr. Dubernard said.
  23. Άρα γιατί ΕΣΥ διάλεξες ιατρική? Λένε ακριβώς τα ίδια τα τελευταία 20 χρόνια. Οπότε δεν μπορείς να πείς πως δεν ήξερες... Πάντως κατά τον Γκίζα (ή την υπογραφή του τουλάχιστον) είναι 45 000 οι γιατροί της Ελλάδας.
  24. Στην Ιταλία έχει εξετάσεις για να μπείς στην ιατρική. Ιταλοί και όλοι της EU δίνουν για τις ίδιες θέσεις. Στην Ιταλία τελειώνουν ανέκαθεν λιγότεροι από όσους αρχίζουν. Χάνονται πάρα πολύ στο δρόμο. Χάνονται πάρα πολλοί στο δρόμο. Οι σπουδές τελικά διαρκούν κατά μέσο όρο πάνω από τα επίσημα 6 χρόνια για την πλειοψηφία των φοιτητών. Ο φοιτητικός συνδικαλισμός στις ιατρικές είναι ανύπαρκτος. Αυτά από Italy.
  25. Ποιά είναι η χώρα με τη μεγαλύτερη κατανάλωση καφέ? Πώς πάει το Alzheimer εκει? I'm a coffee addict too (at least 3 a day)
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