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Tender
Terms modified by Tender Selected AbstractsDeterminants of Institutional Responses to Self,Tender OffersFINANCIAL REVIEW, Issue 3 2002Judith Swisher I examine how institutional investors respond to self,tender offers for common shares. I find that institutions sell more shares in larger offers and with higher proration factors. Institutions also sell more shares when officer and director holdings are not at risk in the offers. Banks, investment advisors, and other managers respond similarly, selling more shares in larger offers. Although institutions as a group do not respond differently by offer type, insurance companies and investment advisors sell more shares in fixed,price offers. Mutual funds, which differ from other types of institutions, sell more shares for firms with greater increases in leverage. [source] Opening up Public Services to Competition by Putting Them Out to Tender: An EvaluationANNALS OF PUBLIC AND COOPERATIVE ECONOMICS, Issue 1 2003P. Bance This article examines the effects of systematizing tendering procedures when awarding public service concessions. The opening up of the water supply industry to competition is used by way of illustration. Results show that arguments in favour of systematization are not robust when focusing solely on the expected benefits of the liberalization process. The peculiarities of the contract relationship in the delegation of public services, the mobilization of specific assets, and the long duration and incompleteness of the contracts invalidate this type of argument and expose public authorities to the opportunism of operators. The efficiency of awarding public services concessions relies on cost,benefit analysis, taking into account sectoral aspects as well as specificities of the contracting organizations and structures. The public service culture of these organizations is in this respect a key factor in the choice of efficient organizations since it conditions their ability to internalize the mission of fulfilling the public interest. [source] EFFECTS OF COOKING METHODS ON SENSORY QUALITIES AND CAROTENOID RETENTION IN SELECTED VEGETABLES,JOURNAL OF FOOD QUALITY, Issue 5 2006MONIQUE D. NUNN ABSTRACT The effects of induction boiling, conventional boiling and microwave steaming on the sensory qualities and carotenoid retention of broccoli, carrots, green beans and sweet potatoes were investigated. Significantly higher cooking yields were obtained for vegetables that were induction and conventionally boiled. No differences in the retentions of alpha-carotene (, -carotene), beta-carotene (, -carotene) and lutein/zeaxanthin were observed for vegetables by the cooking method, with the exception of , -carotene retention in broccoli and sweet potatoes where retentions were higher for those that were induction boiled (90.3 and 86.1%, respectively) than those that were microwave steamed (62.2 and 66.4%, respectively). A trained panel judged the color scores of three vegetables by the cooking method as similar. The mean flavor scores (1 = extremely bland; 9 = extremely intense) for three vegetables that were conventional (4.7,5.4) and induction (5.3,5.5) boiled were lower than those that were microwave steamed (5.9,7.0). The mean texture scores (1 = extremely mushy/tender; 9 = extremely firm/tough) for all induction-boiled (5.0,6.0) vegetables were higher than those that were conventionally boiled (3.4,5.2) and lower than those that were microwave steamed (5.1,6.6). [source] Re: Occupational exposure to pesticides and pancreatic cancer.AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 20012001. To the Editor: In our recent paper describing associations of pancreatic cancer to pesticides, Table I presented JEM scores for selected occupations. We omitted several scores from the table, which indicated less variability across the study than was assessed. We have added all possible scores in Table I to reflect this variability. Also, several scores in the table may need further explanation. The supervisors, food and beverage preparation and food counter, fountain and related occupations had possible exposure to nonagricultural fungicides (i.e. disinfectants). Water and sewage treatment plant operators may handle herbicides to kill algae. Historically, textile mills and some dry cleaning operations applied insecticides to fabric. The subjects with jobs of mixing/blending machine operator/tender, or welder and cutter who were assigned pesticide exposures had worked in the chemical industry where pesticides may have been manufactured. The omissions were only in the reported data and not in the original data, and thus did not affect the epidemiologic results or conclusions. [source] Familial Eccrine Spiradenoma: A Case Report and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 4 2003Maryanna C. Ter Poorten MD BACKGROUND Familial eccrine spiradenoma is a rare autosomal dominant condition that is characterized by slow-growing, benign adnexal tumors. OBJECTIVE We investigated a case of familial eccrine spiradenoma displaying an autosomal dominant inheritance pattern. To our knowledge, only two previously reported cases of familial eccrine spiradenoma exist in the literature. METHODS A case report and review of the literature are given. RESULTS We report a case of familial eccrine spiradenoma in a mother and daughter and present successful treatment using surgical extirpation and CO2 laser ablation. CONCLUSION Familial eccrine spiradenoma is a benign autosomal dominantly inherited condition that is characterized by tender, slow-growing, adnexal tumors of the head and neck. Surgical tumor extirpation and CO2 laser ablation offer both an effective symptomatic and cosmetically elegant treatment option. [source] Mycobacterium avium complex infection in a neck abscess: A diagnostic pitfall in fine-needle aspiration biopsy of head and neck lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2009Valerie A. Fitzhugh M.D. Abstract Fine-needle aspiration biopsy (FNAB) is a useful tool in the diagnosis of mycobacterial disease, especially Mycobacterium tuberculosis. However, nontuberculous mycobacterial infection diagnosed with FNAB material is much rarer, with Mycobacterium avium complex being the most common. In this report, we present the case of a 21-year-old HIV positive man, who presented with a unilateral, tender, enlarging cervical neck mass. FNAB had revealed acute inflammation. Mycobacterium avium complex grew in culture from the material that was aspirated and was confirmed by DNA probe. Because of the paucity of articles on this subject in the cytology literature, it is important to reiterate the value of the material aspirated at the bedside and the clinic in the diagnosis of infectious disease. When faced with antibiotic-resistant cellulitis and abscesses, the FNAB material must be sent for acid fast bacteria smears and culture. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Obstructing sigmoid cancer in a patient with a large, tender, non-reducible inguinal hernia: the obvious diagnosis is not always the correct oneEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2008G.H. SAKORAFAS md We present a 85-year-old patient with intestinal obstruction and a large, tender, non-reducible right inguinal hernia. He was operated with the presumed diagnosis of strangulated inguinal hernia. At surgery, a perforated obstructing sigmoid colon was diagnosed. A sigmoidectomy (Hartman procedure) and hernia repair (Bassini technique) was performed. [source] The Effect of Managerial Ownership on the Short- and Long-run Response to Cash DistributionsFINANCIAL REVIEW, Issue 2 2003Keith M. Howe G32/G35 Abstract We examine both the short-run and long-run responses to the following corporate cash flow transactions: dividend increases and decreases, dividend initiations, and tender offer repurchases. Our focus is the short-run and long-run effects of managerial ownership. We hypothesize that ownership plays an important role in explaining the announcement effects for these events, owing to signaling effects and the reduction of agency problems. Our short-run results accord well with the earlier work on announcement effects for these events and show that firms with high insider ownership exhibit higher excess returns. Our long-term results indicate a drift over a three-year period following the announcement, with the excess returns for the high insider-ownership group becoming more pronounced. [source] Power and Powerlessness: Brecht's Poems to Carola NeherGERMAN LIFE AND LETTERS, Issue 3 2000Joyce Crick This essay is a study of Brecht's poems to Carola Neher: the two versions of 'Rat an die Schauspielerin C.N.' (?1930, ?1956) and 'Das Waschen' (1937). Their dating and textual authority in the three main editions of Brecht's works are a matter of some uncertainty, but the essay suggests a sequence for them that makes sense in the overall pattern of Brecht's life and poetry. They are analysed with two leading questions, particularly acute in the 1930s, in view: what is the nature of the poet's authority; what is the relation of poetry to action? The 'original version' (Elisabeth Hauptmann's term) of the two poems of advice is read as the product of Brecht and Neher's shared success with Die Dreigroschenoper:the poet is in command; the situation is intimate, but the mood is imperative, the gesture as invasive as it is tender; the director is instructing his leading lady how to perform - exemplarily. 'Das Waschen', written from Brecht's exile in Dennmark to Neher in prison in Moscow, is read as the gesture of one powerless to help, but writing into the dark, as a reminder of a - Brecht's word is 'menschenwürdigere' - situation: subdued though it is, the poem carries a charge of memory and muted encouragement. The third porm, a variant of the first, is read as a retreat, lacking the purposeful authority of the first and the paradoxical power in powerlessness of the second. The poems move from celebration to reminder to wish-fulfilment - which is both less and more than Brecht sert out to require of poetry. [source] Metastatic esophageal carcinoma masquerading as inflammatory breast carcinomaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 3 2007Christy L. Nebesio MD A 50-year-old Caucasian woman with a history of esophageal adenocarcinoma presented with a 3-week history of right breast swelling and progressive erythema. Twenty-two months prior to presentation, she had been diagnosed with adenocarcinoma of the esophagus (T3,N1,M1a) and underwent neoadjuvant chemoradiotherapy followed by surgical resection. On physical examination, the right breast was red, swollen (40% larger than the contralateral breast), tender to palpation, and warm to the touch (Fig. 1). No mass was palpable. On the basis of the clinical findings, inflammatory breast carcinoma was suspected. A punch biopsy revealed a poorly differentiated adenocarcinoma with extensive involvement of dermal lymphatics (Fig. 2). The clinical and histologic differential diagnosis included inflammatory breast carcinoma vs. metastatic esophageal adenocarcinoma to the skin of the breast. Figure 1. The affected breast resembled inflammatory breast carcinoma with erythema and prominent edema. The edema resulted in partial inversion of the nipple Figure 2. Within the reticular dermis and dermal lymphatics, there was a poorly differentiated adenocarcinoma. Many of the tumor cells had a signet ring morphology (hematoxylin and eosin, ×200) To resolve this question, immunohistochemical stains for estrogen and progesterone receptors and CDX-2 (BioGenex, San Ramon, CA, USA) were performed. CDX-2 is an intestinal homeobox gene expressed in gastrointestinal epithelium and gastrointestinal tumors. The tumor nuclei were positive for CDX-2 but negative for both steroid receptors (Fig. 3), confirming the diagnosis of metastatic esophageal adenocarcinoma. Figure 3. The tumor cells had strong nuclear immunoreactivity for CDX-2 (CDX-2 immunohistochemical stain, ×400) [source] Necrotizing fasciitis: delay in diagnosis results in loss of limbINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2006Rajat Varma MD A 58-year-old man presented to the Emergency Room with a 1-day history of severe pain in the left lower extremity preceded by several days of redness and swelling. He denied any history of trauma. He also denied any systemic symptoms including fever and chills. His past medical history was significant for diabetes, hypertension, deep vein thrombosis, and Evans' syndrome, an autoimmune hemolytic anemia and thrombocytopenia, for which he was taking oral prednisone. Physical examination revealed a warm, tender, weeping, edematous, discolored left lower extremity. From the medial aspect of the ankle up to the calf, there was an indurated, dusky, violaceous plaque with focal areas of ulceration (Fig. 1). Figure 1. Grossly edematous lower extremity with well-demarcated, dusky, violaceous plaque with focal ulceration Laboratory data revealed a white blood cell count of 6.7 × 103/mm3[normal range, (4.5,10.8) × 103/mm3], hemoglobin of 11.5 g/dL (13.5,17.5 g/dL), and platelets of 119 × 103/mm3[(140,440) × 103/mm3]. Serum electrolytes were within normal limits. An ultrasound was negative for a deep vein thrombosis. After the initial evaluation, the Emergency Room physician consulted the orthopedic and dermatology services. Orthopedics did not detect compartment syndrome and did not pursue surgical intervention. Dermatology recommended a biopsy and urgent vascular surgery consultation to rule out embolic or thrombotic phenomena. Despite these recommendations, the patient was diagnosed with "cellulitis" and admitted to the medicine ward for intravenous nafcillin. Over the next 36 h, the "cellulitis" had advanced proximally to his inguinal region. His mental status also declined, and he showed signs of septic shock, including hypotension, tachycardia, and tachypnea. Vascular surgery was immediately consulted, and the patient underwent emergency surgical debridement. The diagnosis of necrotizing fasciitis was then made. Tissue pathology revealed full-thickness necrosis through the epidermis with subepidermal splitting. Dermal edema was also present with a diffuse neutrophilic infiltrate (Fig. 2). This infiltrate extended through the fat into the subcutaneous tissue and fascia. Tissue cultures sent at the time of surgery grew Escherichia coli. Initial blood cultures also came back positive for E. coli. Anaerobic cultures remained negative. Figure 2. Necrotic epidermis with subepidermal splitting. Marked dermal edema with mixed infiltrate and prominent neutrophils. Hematoxylin and eosin: original magnification, ×20 After surviving multiple additional debridements, the patient eventually required an above-the-knee amputation due to severe necrosis. [source] Bullous variant of Sweet's syndromeINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2005Susanne Voelter-Mahlknecht MD A 69-year-old woman presented to our clinic as an emergency with erythematous, well-circumscribed plaques, which were partly vesicular, on her extremities and in her armpits, and additionally hemorrhagic blisters on both her palms and her fingers (Fig. 1a), which had developed 2 days after the first appearance of the skin lesions. The rapid onset of the lesions (within a few hours) and the pain associated with them were extremely troublesome to the patient. On admission she complained of fever, tiredness and being easily fatigued. Because of a urinary tract infection 1 month prior to admission, trospiumchloride was given. On clinical examination, body temperature was found to be above 38 °C and infraclavicular lymph nodes were enlarged but not tender. Figure 1. (a) Bullae on the patient's right hand. (b) Multiple partly confluent vesicles with neutrophilic granulocytes intraepidermally and a dense interstitial perivascular infiltration of neutrophilic granulocytes and lymphomononuclear cells (H&E, ×200) Normal or negative laboratory tests included blood counts, liver and kidney parameters, electrolytes and infection screen. Laboratory examination demonstrated minor leukocytosis and absolute neutrophilia (white blood cell count 10 440 cells/µL, neutrophils 8030 cells/µL). X-ray screening, abdominal ultrasound and laboratory investigations were all normal. There was no response to antibiotics when erythromycine was given. However, there was a good response to systemic corticosteroids. The patient was treated with a low dosage of prednisolone, beginning at 50 mg/day, which was then tapered off. Skin lesions resolved within 7 days. Histology from a lesion on the patient's left forearm showed a dense interstitial inflammatory infiltration consisting predominantly of neutrophilic granulocytes from the subepidermal layer to the middle of the reticular dermis. Inflammatory cells penetrated into both blood vessels and vessel walls; vasculitis was not prominent. In the lower dermis, perivascular infiltrations of lymphomononuclear cells were found. In addition, intraepidermally multiple partly confluent vesicles, with inclusions of neutrophilic granulocytes, were found, confirming the diagnosis of this rare variant of an acute febrile neutrophilic dermatosis (Fig. 1b). [source] Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2002Zeynep Demirçay MD Case 1,A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm × 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. Case 2,A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1500 mg/day, for the past 5 years. Interferon-,-2b was started 3 months ago, in addition to HU, which was tapered to 1000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. Case 3,A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm × 2 cm over the right lateral malleolus (Fig. 1). Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care. Figure 1. Punched-out ulcer surrounded by an erythematous border over the right malleolus (Case 3) [source] Acute febrile neutrophilic dermatosis (Sweet's syndrome) with nodular episcleritis and polyneuropathyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2002Taizo Kato MD A 56-year-old Japanese housewife presented with multiple erythematous lesions in association with ocular hyperemia and pain in the right upper and lower extremities, including the hands and feet. These symptoms were preceded by a sore throat with persistent fever higher than 38.5 °C for about 1 week. Dermatologic examination showed tender, dull-red, erythematous lesions, measuring 1,2 cm in diameter, located predominantly on the forehead, cheeks, auricular region, neck, forearm, hands, and feet. A biopsy specimen obtained from an erythematous lesion on the right forearm revealed prominent edema in the papillary dermis and remarkable inflammatory cell infiltration throughout the entire dermis (Fig. 1). The infiltrate predominantly consisted of neutrophils and nuclear dust without signs of vasculitis. In routine examination, the leukocyte count was 15,000/mL (normal range, 4000,8000/mL) with severe neutrophilia (80%). The C-reactive protein (CRP) level was 17.65 mg/dL (normal range, < 0.5 mg/dL) and the anti-streptolysin (ASLO) level was 611 IU/mL (normal range, < 166 IU/mL). In human leukocyte antigen (HLA) testing, HLA-A2, -B39, -B35, -Cw2, and -Cw7 were positive, and HLA-B51, -B54, and -Cw1 were negative. Figure Figure 1 . Histologic picture showing a dermal infiltrate of neutrophils Ocular hyperemia was caused by episcleritis forming a nodule and surrounding congestion of the superficial episcleritic vessels at the central portion of the sclera (Fig. 2). The patient suffered from pain once an hour, continuing for about 3 min, at the lateral portion of the right upper and lower extremities, as well as the right small finger. Neurologic examination demonstrated moderate or slight muscle weakness in the extremities. Hand grasping powers were 9 and 7 kg on the right and left, respectively. The patient was right-handed. Dysesthesia and paresthesia were also observed on the hands and feet. The deep tendon reflexes were preserved, however, even in the distal portion of the upper and lower limbs. In addition, essential tremor localized to the neck was recognized. Magnetic resonance imaging did not show any episodes of transient abnormal signal intensity in the central nervous system. Figure 2. Nodular episcleritis (right eye). Telangiectasia of winding vessels with nodular elevation was observed at the upper portion of the sclera The patient was treated with prednisolone (initial dose of 30 mg/day) and intravenous injection of cefazolin sodium (2 g/day for 5 days). Almost complete regression of the ocular and neurologic manifestations, as well as the skin lesions, was achieved in 2 weeks. Prednisolone was reduced gradually and suspended after 4 weeks. Leukocyte and neutrophil counts, CRP, and ASO returned to normal on suspension of therapy. Slight paresthesia remained in the right small finger even after stopping steroid. There was no recurrence at follow-up 6 months later. [source] Metastatic cutaneous leiomyosarcoma from primary neoplasm of the mesenteryINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2001Kyoung Jin Kim MD A 31-year-old South Korean woman was referred to the dermatology department from the oncology department for the evaluation of a subcutaneous nodular lesion on the back. Three years before, she noted a palpable, fingertip-sized, nontender mass on her right lower abdomen. The mass had increased in size slowly. One year ago, she visited a local clinic and physical examination revealed a 7 × 8 × 7 cm, slightly tender, deep-seated mass on the right lower quadrant of the abdomen. The mass on the ilial mesentery was resected by surgical exploration and tissue examination revealed leiomyosarcoma. She refused adjuvant chemotherapy. Approximately 3 months later, she re-visited the clinic with a tender, subcutaneous nodule on the back. Cutaneous examination revealed a solitary, 2 × 2 cm, well-defined, hard, movable, subcutaneous nodule on the upper back without skin color change (Fig. 1). She complained of tenderness on touching the lesion. Histologic examination of a biopsy specimen showed irregularly arranged spindle cells scattered throughout the dermis. They were arranged in haphazardly oriented or interweaving fascicles. Most of the spindle cells possessed elongated nuclei with blunt ends and some cells had a polygonal outline with irregularly shaped nuclei (Fig. 2). There were many mitoses: 3,4 per high-power (× 400) field. Immunohistochemically, smooth muscle actin and desmin were positive in most of the tumor cells (Fig. 3). S-100 reactivity was not observed. A diagnosis of metastatic leiomyosarcoma was made. About 1 month later, computed tomography showed two, ill-defined, heterogeneous, low attenuation masses in the right lobe of the liver, suggesting liver metastasis. The patient was treated with chemotherapy for 2 months and remains in good condition. Figure 1. 2 × 2 cm, solitary, well-defined, hard, movable, subcutaneous nodule without any overlying skin change Figure 2. (a) Characteristic findings of cutaneous leiomyosarcoma with markedly high cellularity and densely packed transverse and longitudinal fascicles of cells (hematoxylin and eosin, × 40). (b) High magnification of the neoplasm revealing spindle cells with blunt-ended nuclei, pleomorphism, and mitotic figures (hematoxylin and eosin, × 200) Figure 3. Dense cytoplasmic reactivity for smooth muscle actin is apparent (smooth muscle actin, × 200) [source] Eccrine poroma of the heelINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2000Harvey Lemont A 67-year-old African,American woman had a tender red nodule on the posterior aspect of her left heel of 20 years' duration. The lesion had initially grown quickly to its present size, but subsequently remained unchanged through the years. No previous history of trauma to the area could be elicited. The lesion was not tender or painful, although the patient related some recent discomfort when wearing shoes with high heel counters. Examination revealed a soft, multilobulated, skin-colored nodule, measuring approximately 1.1 cm at its greatest diameter ( Fig. 1), with a rim space or moat ( Fig. 2) surrounding the lesion. Biopsy of the lesion demonstrated a uniform proliferation of basaloid cells exhibiting a sharp demarcation between the adjacent normal epidermis ( Fig. 3). No horn cysts were present. The papillary dermis demonstrated multiple ectatic blood vessels ( Fig. 4) which may be responsible for its reddish appearance. Figure 1 Multilobulated,. red, granulating lesion on the posterior heel Figure 2 Note. the characteristic ,,moat'' surrounding the lesion Figure 3 Biopsy. reveals a proliferation of uniformly small cuboidal cells sharply demarcated from the adjacent normal epidermal cells Figure 4 Ectatic. vessel dilatation most likely responsible for the reddish color of the lesion [source] A child with spider bite and glomerulonephritis: a diagnostic challengeINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2000Jennifer M. Lung MD A previously healthy 7-year-old white boy presented to St. Louis Children's Hospital with a 1-day history of headache, malaise, temperature of 38.7 °C, and a progressively erythematous, tender calf with central dusky purpura. On the morning of admission, his mother noticed a 2-mm crust on the patient's right calf with a 3-cm × 3-cm area of surrounding erythema. No history of recent trauma or bite was obtained. He had suffered two episodes of nonbloody, nonbilious emesis during the last day. In addition, over the previous 12 h, he presented brown urine without dysuria. His mother and brother had suffered from gastroenteritis over the previous week without bloody diarrhea. On initial physical examination, there was a 6-cm × 11-cm macular tender purpuric plaque with a central punctum on the right inner calf, which was warm and tender to the touch, with erythematous streaking towards the popliteal fossa ( Fig. 1). The inguinal area was also erythematous with tender lymphadenopathy and induration, but without fluctuance. Laboratory studies included an elevated white blood cell count of 20,800/,L with 6% bands, 86% segs, and 7% lymphocytes, hemoglobin of 12.5 g/dL, hematocrit of 35.1%, and platelets of 282,000/,L. The prothrombin time/activated partial tissue thromboplastin was 10.4/28.0 s (normal PT, 9.3,12.3 s; normal PTT, 21.3,33.7 s) and fibrinogen was 558 mg/dL (normal, 192,379 mg/dL). Urinalysis showed 1+ protein, 8,10 white blood cells, too numerous to count red blood cells, and no hemoglobinuria. His electrolytes, blood urea nitrogen (BUN), and creatine were normal. The urine culture was negative. Blood culture after 24 h showed one out of two bottles of coagulase negative Staphylococcus epidermidis. Figure 1. (A) 7-year-old boy with painful purpura of the calf The patient's physical examination was highly suggestive of a brown recluse spider bite with surrounding purpura. Over the next 2 days, the surrounding rim of erythema expanded. The skin within the plaque cleared and peeled at the periphery. The coagulase negative staphylococci in the blood culture were considered to be a contaminant. Cefotaxime and oxacillin were given intravenously. His leg was elevated and cooled with ice packs. The patient's fever resolved within 24 h. The lesion became less erythematous and nontender with decreased warmth and lymphadenopathy. The child was discharged on Duricef for 10 days. Because the patient experienced hematuria rather than hemoglobinuria, nephritis was suggested. In this case, poststreptococcal glomerulonephritis was the most likely cause. His anti-streptolysin-O titer was elevated at 400 U (normal, <200 U) and C3 was 21.4 mg/dL (normal, 83,177 mg/dL). His urine lightened to yellow,brown in color. His blood pressure was normal. Renal ultrasound showed severe left hydronephrosis with cortical atrophy, probably secondary to chronic/congenital ureteropelvic junction obstruction. His right kidney was normal. [source] Dermatomyositis presenting as panniculitisINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2000Yen-Yu Chao MD A 44-year-old obese woman was transferred to our clinic with a diagnosis of panniculitis. Examination showed multiple, indurated, erythematous, painful nodules and plaques distributed on the shoulders, back, forechest, abdomen, buttock, and bilateral thighs. These skin lesions appeared 2 months previously, measured 5,8 cm, and were tender on palpation. No obvious inducing factor was traced. The lesions seemed unresponsive to treatment with nonsteroidal anti-inflammatory drugs (ibuprofen, 400 mg three times a day) as similar lesions appeared in subsequent visits. Progressive proximal muscle weakness was found 1 month later. She was then admitted via the emergency room because of extensive painful skin plaques and abdominal pain. Diffuse erythematous to violaceous swelling of the face, neck, and shoulder was noted at about the same time ( Fig. 1). A skin biopsy specimen from the nodular lesion showed poikilomatous epidermal changes ( Fig. 2), and marked mononuclear cell infiltration in the dermis and subcutaneous fat ( Fig. 3). Dermatomyositis was considered as the diffuse violaceous facial erythema could be a form of heliotrope eruption, but Gottron's papule was not found. At admission, serum creatinine phosphokinase (CPK) was mildly elevated (436 IU/L; normal range, 20,170 IU/L), but serum asparagine transaminase (AST) and lactate dehydrogenase (LDH) levels were within normal limits (36 IU/L; normal, 11,47 IU/L; and 108 IU/L; normal, 90,280 IU/L, respectively). Antinuclear antibody was 1 : 80 positive with an atypical speckled pattern. Muscle strength was weakest during the first 2 days, about grade 3 by the Medical Research Council (MRC) of Great Britain scale. Gower's sign was positive. An electromyogram showed myopathic changes and a nerve conduction velocity study was normal. Serum enzymes were elevated further on the third day: AST, 55 IU/L; CPK, 783 IU/L with 100% MM form. The diagnosis of dermatomyositis was established. As for the work-up result, anti-dsDNA antibody, anti-ENA antibody, and anti-Jo1 antibody were negative. Tumor marker screen (,-HCG, AFP, CEA, and CA-125), was negative, and rhinolaryngopharyngoscope examination and gynecologic sonography were normal. Figure 1. Diffuse erythematous swelling with subtle violaceous hue extending from the temporal area to the cheeks, neck, and shoulders. The crusted lip ulcers of herpes simplex were also noted Figure 2. Basketweave hyperkeratosis, mild acanthosis, subtle vacuolar degeneration of the basal cells, and melanin incontinence (hematoxylin and eosin, ×400) Figure 3. Heavy mononuclear cells infiltrated in the subcutaneous fat tissue (hematoxylin and eosin, ×100) Pancreatitis was initially suspected because of epigastric pain and tenderness, elevated serum lipase (382 U/L; normal, 23,200 U/L), and amylase (145 U/L; normal, 35,118 U/L). No evidence of pancreatitis could be found in abdominal sonography and abdominal computed tomography (CT), however. The epigastric pain and tenderness subsided soon after admission and the serum pancreatic enzyme level declined on the second day (amylase 69 U/L; lipase, 276 U/L). The patient was then diagnosed with dermatomyositis and treated with prednisolone (120 mg/day). CPK dropped dramatically from 3286 IU/L the day before treatment to 1197 IU/L 3 days after. Panniculitis lessened and the muscle power improved after 1 week of treatment. The disease activity fluctuated even with treatment with prednisolone and the patient often felt listless and weak. The muscle weakness sometimes deteriorated to affect the patient's mobility. Facial erythema and panniculitis-like lesions were found during the worse times. Methotrexate and azathioprine were then added (7.5 mg and 250 mg per week, respectively), but CPK was still mildly elevated (189 IU/L), and the patient still felt ill. Human immune globulin (5%, 500 mL per day, 5 days per month) intravenous infusion was initiated thereafter. There was a dramatic response. Full muscle strength was retained and CPK was within the normal range in the following 6 months with only immune globulin therapy. [source] Can grazing response of herbaceous plants be predicted from simple vegetative traits?JOURNAL OF APPLIED ECOLOGY, Issue 3 2001Sandra Díaz Summary 1,Range management is based on the response of plant species and communities to grazing intensity. The identification of easily measured plant functional traits that consistently predict grazing response in a wide spectrum of rangelands would be a major advance. 2,Sets of species from temperate subhumid upland grasslands of Argentina and Israel, grazed by cattle, were analysed to find out whether: (i) plants with contrasting grazing responses differed in terms of easily measured vegetative and life-history traits; (ii) their grazing response could be predicted from those traits; (iii) these patterns differed between the two countries. Leaf mass, area, specific area (SLA) and toughness were measured on 83 Argentine and 19 Israeli species. Species were classified by grazing response (grazing-susceptible or grazing-resistant) and plant height (< or > 40 cm) as well as by life history (annual or perennial) and taxonomy (monocotyledon or dicotyledon). 3,Similar plant traits were associated with a specific response to grazing in both Argentina and Israel. Grazing-resistant species were shorter in height, and had smaller, more tender, leaves, with higher SLA than grazing-susceptible species. Grazing resistance was associated with both avoidance traits (small height and leaf size) and tolerance traits (high SLA). Leaf toughness did not contribute to grazing resistance and may be related to selection for canopy dominance. 4,Plant height was the best single predictor of grazing response, followed by leaf mass. The best prediction of species grazing response was achieved by combining plant height, life history and leaf mass. SLA was a comparatively poor predictor of grazing response. 5,The ranges of plant traits, and some correlation patterns between them, differed markedly between species sets from Argentina and Israel. However, the significant relationships between plant traits and grazing response were maintained. 6,The results of this exploratory study suggest that prediction of grazing responses on the basis of easily measured plant traits is feasible and consistent between similar grazing systems in different regions. The results challenge the precept that intense cattle grazing necessarily favours species with tough, unpalatable, leaves. [source] Tuberculids as sentinel lesions of tuberculous epididymo-orchitisJOURNAL OF CUTANEOUS PATHOLOGY, Issue 11 2007Pratistadevi K. Ramdial Background:, Tuberculids are rarely associated with male genital tract tuberculosis (TB). Tuberculous epididymo-orchitis (TBEO) has been associated rarely with papulonecrotic tuberculid (PNT) but not with erythema induratum (EI) or the simultaneous occurrence of different tuberculids. Methods:, A retrospective assessment of tuberculids that occurred with underlying TBEO was carried out. Results:, Five patients, four with one and one with two skin biopsies, with clinical diagnoses of PNT (two), EI (one), impetigo (two) and calf ulcer (one), formed the study cohort. Histopathological evaluation confirmed PNT and EI in four and two skin biopsies, respectively. Two patients who returned for follow-up were commenced on anti-tuberculous therapy. All patients sought medical attention 3,34 months later for tender right-sided (two) and left-sided (three) testicular masses. Orchidectomy was undertaken following a poor clinical response to empirical treatment with trimethoprim sulfamethoxazole. Pathological examination of the testis and epididymis confirmed TBEO. The patients were initiated on anti-tuberculous therapy. There was dramatic healing of the skin lesions. Conclusion:, Tuberculids are a sentinel cutaneous manifestation of visceral TB and a valuable external audit of treatment compliance and response. Heightened recognition of and more rigorous genitourinary tract investigation are necessary to identify occult or asymptomatic TBEO as the underlying cause of tuberculids. [source] SENSORY EVALUATION OF BROILED AND GRILLED BISON PATTIES BY TRAINED PANELISTS,JOURNAL OF FOOD QUALITY, Issue 4 2001JAYNE M. McCLENAHAN ABSTRACT Sensory characteristics of broiled and grilled patties from grain-fed bison were evaluated by a 13-member trained sensory panel. Ground patties (approximately 113 g, 12.2 cm diameter, 0.9 cm thick) from 6 grinding dates were broiled (260C) or grilled (163C) to 71C internal temperature. Cooking time was significantly shorter (p < 0.0001) for grilled than broiled patties, while cooking yields were similar. Broiled patties were judged to have a more gray than brown surface color, a more red than gray interior color, to be more juicy, and to be more tender than grilled, while their aromatic and flavor intensities were similar. [source] Changes in Tenderness, Color, and Water Holding Capacity of Broiler Breast Meat during Postdeboning AgingJOURNAL OF FOOD SCIENCE, Issue 8 2009Y.S. Lee ABSTRACT:, The impact of postharvest aging on the tenderness, color, water holding capacity, and appearance of broiler breast fillets after deboning was investigated. A total of 360 broilers were processed and deboned at either 1.5-, 3-, or 6-h postmortem (PM) and aged at 4 ± 1 °C for up to 6 d. Tenderness was predicted by the Meullenet,Owens razor shear. Drip loss, cook loss, color, and muscle-shape profiles were also evaluated during the 6-d aging duration. Deboned fillets were in the tenderness range corresponding to "neither tough nor tender" for the first 2 d of aging and changed into "slightly tender" after 3 d of aging according to the instrument-tenderness perception equivalent scale. Tenderization due to postdeboning aging seemed to be more pronounced for fillets deboned in a prerigor state (that is, 1.5- and 3-h PM). Over the aging period, tenderness improved by 6.9 and 7.4 percentage points for the 1.5- and 3-h PM treatments, respectively, while those fillets deboned in a postrigor state (6-h PM) exhibited no significant difference in tenderness. Drip and cook loss of fillets consistently increased over the aging period. The color of fillets tended to become less red and more yellow during aging although there was no significant difference in,L*. Overall, the tenderizing effects of deboned broiler breast fillets during the storage of 6 d were minimal but seemed to be affected by fillet height and length as determined through analysis of covariance (ANCOVA) and K-means clustering analysis. Thicker and tougher fillets were more susceptible to the tenderizing effects during postdeboning aging. [source] Effects of areca nut extracts on the functions of human neutrophils in vitroJOURNAL OF PERIODONTAL RESEARCH, Issue 4 2000Shan-Ling Hung Aqueous extracts of ripe areca nut without husk (ripe ANE) and fresh and tender areca nut with husk (tender ANE) were examined for their effects on the defensive functions of human neutrophils. Exposure of peripheral blood neutrophils to ripe ANE and tender ANE inhibited their bactericidal activity against oral pathogens, including Actinobacillus actinomycetemcomitans and Streptococcus mutans, in a dose-dependent manner. At the concentrations tested, ripe and tender ANEs did not significantly affect the viability of neutrophils as verified by their ability to exclude trypan blue dye. However, both ANEs inhibited the production of bactericidal superoxide anion by neutrophils as measured by cytochrome c reduction. Moreover, the ripe ANE inhibited neutrophils more effectively than did tender ANE. Arecoline, a major alkaloid of areca nut, only exhibited an inhibitory effect on the functions of neutrophils when high concentrations were used. Therefore, arecoline could not be used to explain the inhibitory effects observed for ANEs. In conclusion, our results demonstrated that ripe and tender ANEs reduced the antibacterial activity and the superoxide anion production of neutrophils. This effect may contribute to a less efficient elimination of bacteria from the periodontal environment. Inhibition of the antimicrobial functions of neutrophils may alter the microbial ecology of the oral cavity, and this may be one possible mechanism by which areca nut compromises the oral health of users of areca nut products. [source] Complications of fractional CO2 laser resurfacing: Four casesLASERS IN SURGERY AND MEDICINE, Issue 3 2009Douglas J. Fife MD Abstract Background and Objective Fractional ablative laser therapy is a new modality which will likely be widely used due to its efficacy and limited side-effect profile. It is critical to recognize, characterize, and report complications in order to acknowledge the limits of therapeutic efficacy and to improve the safety of these devices. Study Design/Materials and Methods The photographs, treatment parameters, and clinical files of four female patients aged 54,67 who had scarring or ectropion after fractional CO2 laser resurfacing on the face or neck were carefully reviewed to search for any possible linking factors. Results Patient 1 developed erosions and swelling of the right lower eyelid 2 days postoperatively, which developed into scarring and an ectropion. Patient 2 developed linear erosions and beefy red swelling on the right side of the neck which developed into a tender, band-like scar over 1-month. Patient 3 developed stinging and yellow exudate in multiple areas of the neck 3 days postoperatively. Cultures grew methicillin-resistant Staphylococcus aureus. Despite appropriate treatment, she developed multiple areas of irregular texture and linear streaking which developed into scars. Patient 4 developed an asymptomatic patchy, soft eschar with yellowish change on the left side of the neck. Azithromycin was started, however at 2-week follow-up she had fibrotic streaking which developed into horizontal scars and a vertical platysmal band. The treatment and final outcome of each patient are described. Conclusion Scarring after fractional CO2 laser therapy may be due to overly aggressive treatments in sensitive areas (including excessive energy, density, or both), lack of technical finesse, associated infection, or idiopathic. Care should be taken when treating sensitive areas such as the eyelids, upper neck, and especially the lower neck and chest by using lower energy and density. Postoperative infections may lead to scarring and may be prevented by careful taking of history, vigilant postoperative monitoring and/or prophylactic antibiotics. Lasers Surg. Med. 41:179,184, 2009. © 2009 Wiley-Liss, Inc. [source] Protecting the environment through public procurement: The case of South AfricaNATURAL RESOURCES FORUM, Issue 1 2008Phoebe Bolton Abstract This article deals with the use of the procurement or purchasing power of governments to protect the environment. The focus is on South Africa and the aim is to show that South African organs of state can use procurement as an environmental policy tool to contribute to sustainable development as they have commendably done so to address past discriminatory policies and practices. It is argued that such use does not fall outside the current legislative framework governing procurement and suggestions are made as to how environmental considerations could be incorporated throughout the procurement process, namely the preparatory stage; the drawing up of tender or technical specifications; ensuring the capability or responsibility of contractors; the use of criteria to compare different tenders; and ensuring that eventual performance under a contract is environmentally sound. [source] The Presence of Love in Ethical CaringNURSING FORUM, Issue 1 2006Maria Arman RNM Caring as a virtue and an act of ethics is from both a natural and a professional point of view inseparably related to love as a universal/ontological value. Love is shown, like suffering and death, to be a concept of universal or metacharacter. From current nursing/caring science as well as from ethical and philosophical perspectives, this paper explores how love can be visible in caring through virtue and that the art of caring creates its evidence. The ethical and existential practicing of love, particularly unselfish love, allows a caregiver to come distinctly closer to the essence of his or her own personality and to live in a more authentic manner. Obstacles and alienation in caregivers that induce a holding back of one's own natural impulses to give the suffering patient tender, dignified care are examined. Economy, paradigm, and caring culture are cited, but ultimately it is a question concerning every caregiver's decision and responsibility to come forward to serve those the caregiver is actually there to represent, the suffering patient. This does not always require new knowledge, rather, liberation of the inner life and authenticity in caregivers. Love, if viewed only as a phenomenon without connection to a universal or ontological philosophy, risks being a problematic concept for caring science. If, on the other hand, it is viewed as the ontological basis for caring and ethical acts, then we can look for and practice phenomenological expressions for love that can enhance the patient's understanding of life as well as giving relief from suffering. [source] Modified atmosphere packaging affects lipid oxidation, myofibrillar fragmentation index and eating quality of beefPACKAGING TECHNOLOGY AND SCIENCE, Issue 2 2009Ina Clausen Abstract The objective of this study was to evaluate the effects of different modified atmosphere packaging (MAP) systems applied during ageing and retail display on the quality of beef longissimus dorsi. The quality of the steaks was measured by sensory analysis, thiobarbituric acid-reactive substances (TBARS), myofibrillar fragmentation index (MFI), protein oxidation, weight loss, cooking loss and vitamin E content. The study included 11 different packaging systems investigated in two separate trials, using O2, CO2, N2 gas and vacuum in combination or alone during ageing and retail display. In some systems, loins were sliced into steaks before packaging, and in other systems, loins were vacuum packed and aged for 14,18 days, and thereafter were sliced and repacked in different atmospheres. Systems including high O2 MAP resulted in a large increase in warmed-over flavour and in TBARS as well as a decrease in juiciness, tenderness and vitamin E content, compared to anaerobic systems. Also, MFI was lower in high O2 MAP steaks, and an increase in protein oxidation was seen, suggesting that the decrease in meat tenderness was due to reduced proteolysis and/or protein oxidation. In addition, the cooked steaks of high O2 MAP looked well done, although the internal temperature was only 62°C, indicating premature browning. Ageing of steaks in N2 did not affect any measured parameter compared to vacuum thermoforming packed muscle. Steaks stored in vacuum skin pack for 20 days were less tender than steaks stored in 100% N2 for 18 days followed by 2 days in atmospheric air. In conclusion, packaging in high O2 concentrations compromises several aspects of meat quality. Copyright © 2008 John Wiley & Sons, Ltd. [source] CLUSTERED SYNERGIES IN THE TAKEOVER MARKETTHE JOURNAL OF FINANCIAL RESEARCH, Issue 4 2008Jeff Madura Abstract In a competitive market for takeover bids, the takeover premium serves as an effective proxy for the expected synergy. We find that the expected synergy is primarily related to the premiums paid in other recent takeovers in the same industry. This relation is even stronger when considering previous takeovers (especially over the previous three-month horizon) in the same industry that have the same payment method (cash versus stock) or form of takeover (tender offer versus merger). More of the variation in expected synergies among takeovers can be explained by the premiums derived from recent takeovers in the same industry than by all bidder- and target-specific characteristics combined. We also find that the bidder valuation effects are inversely related to the premium paid for targets, implying that abnormally high premiums may reflect overpayment rather than abnormally high synergies. [source] Bilateral testicular tuberculomas: a case detectionANDROLOGIA, Issue 2 2009A. Hassan Summary Genitourinary tuberculosis (TB) is the most frequent manifestation of extrapulmonary TB, where the epididymides, seminal vesicles and prostate are the commonly infected sites, followed by the testes. We report a 29-year-old man who presented with primary infertility since 2 years. He had a history of bilateral painful scrotal swelling with fever since 4 years, diagnosed as pyogenic scrotal abscess, which was managed by incision and drainage. At presentation, fever, weight loss and night sweats were absent. On examination, he had ovoid slightly tender, firm to hard irregular masses in the lower poles of both testes with no line of separation encroaching on both epididymes. Both testes were not felt distinctly and the overlying scrotal skin showed no signs of inflammation. Semen analysis revealed azoospermia. Scrotal colour coded duplex ultrasonography demonstrated moderately enlarged testes having well defined hypoechoic masses with foci of calcifications. Magnetic resonance imaging confirmed these findings. Biopsy and histopathology detected the presence of caseating granuloma and Ziehl,Neelsen staining of paraffin sections demonstrated acid-fast bacilli. The patient was treated with combination therapy. Tracing of the condition is discussed. [source] The influence of fig proteases on the inhibition of angiotensin I-converting and GABA formation in meatANIMAL SCIENCE JOURNAL, Issue 6 2009Jinyue LI ABSTRACT The purposes of this research were to use fig protease for texture tenderizing, and to inhibit angiotensin I-converting enzyme (ACE) action and ,-aminobutyric acid (GABA) formation of meat. Liberated peptides by the enzymatic action of fig protease in processing meat and free amino acids were determined and ACE inhibitory activity was assayed. Meat treated with fig protease became tender as indicated by shear force value (SFV) which was half of those of non-fig treated meat during storage even at 5°C. Liberated peptides, free amino acids and GABA increased while extremely low levels of Glu were detected after storage. The optimal temperature of fig protease against meat was 80°C. However, the activity of fig protease decreased after pre-heating more than 40°C. High ACE inhibitory activity of a mixture of fig and meat was found around 80°C, and the value corresponded to the amount of liberated peptide. A lot of liberated peptides were found at 60,80°C and pasterization of meat product becomes convenient to produce peptides. Production of ACE inhibitory peptides and GABA can be expected as the healthy functional meat product such as antihypertensive activity and improve brain function. [source] | ||||||||||||||||||||||