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Difficult Condition (difficult + condition)
Selected AbstractsTreatment of Pigmented Hypertrophic Scars with the 585 nm Pulsed Dye Laser and the 532 nm Frequency-Doubled Nd:YAG Laser in the Q-Switched and Variable Pulse Modes: A Comparative StudyDERMATOLOGIC SURGERY, Issue 8 2002Leyda Elizabeth Bowes MD background. Pigmented hypertrophic scars are a difficult condition to treat. They may result from traumatic injuries or from surgical and cosmetic procedures. The 585 nm flashlamp-pumped pulsed dye laser (FLPDL) has been used to treat this condition, with significant improvement of varying degrees. It remains to be determined whether other laser modalities may have a similar or even greater success in the treatment of pigmented hypertrophic scars. objective. To determine the efficacy of the 532 nm frequency-doubled Nd:YAG laser in the treatment of pigmented hypertrophic scars as compared to the 585 nm FLPDL. methods. Six patients with pigmented hypertrophic scars and skin phototypes II,IV were chosen. A scar was selected for treatment in each patient and divided into four equal 2 cm segments. Three segments were each treated with a different laser modality and one was left untreated to serve as the control. A 585 nm FLPDL was used with an energy of 3.5 J, a pulse duration of 450 ,sec, and a 10 mm spot size. A 532 nm Q-switched frequency-doubled Nd:YAG laser was set to an energy of 2.8 J, a 10-nsec pulse, and a 3 mm spot size. The same 532 nm laser was set to the variable pulse mode to treat a 2 cm scar segment, with an energy of 9.5 J, a 10-msec pulse, and a 4 mm spot size. An average of 3.3 treatments were performed on each scar segment, at intervals of 4,6 weeks and long-term follow-up at 22 weeks. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. A SigmaStat t -test was used to determine the statistical significance of the values obtained. results. Treatment of pigmented hypertrophic scars with the 532 nm Q-switched Nd:YAG laser led to a significant improvement of 38% in the VGH scores when compared to baseline (P = .005). The 585 nm FLPDL also had a favorable effect on the scars, with an average improvement of 36.1% in the VGH scores. There was no significant difference noted between the outcome of treatment with either of these two lasers. Treatment with the 532 nm variable pulse Nd:YAG laser led to a 19% improvement in the VGH scores of scars, which did not differ significantly from the 16.1% improvement observed in control scars on the last follow-up visit. No side effects or complications from treatment were noted or reported during the course of the study. At the conclusion of the study, five of six patients chose the segment treated with the 532 nm Q-switched Nd:YAG laser as the best segment overall. conclusion. The 532 nm Q-switched Nd:YAG laser and the 585 nm FLPDL offer comparable favorable results in the treatment of pigmented hypertrophic scars. The 532 nm Q-switched Nd:YAG laser may be preferred by patients particularly distressed by the dark color of their scars. [source] Hepatic steatosis and its relationship to transplantationLIVER TRANSPLANTATION, Issue 5 2002Charles J. Imber FRCS Fatty infiltration of the liver is common in the brain-dead donor population and has a strong correlation with primary nonfunction after cold preservation, a condition that is catastrophic to liver transplant recipients. This literature review examines factors associated with the development, diagnosis, quantification, and clinical management of this difficult condition. [source] Herpes zoster in older adults. (Duke University Medical Center, Durham, NC) Clinical Infectious Diseases.PAIN PRACTICE, Issue 4 20011486., 2001;32:148 Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key aged-related clinical, epidemiological, and treatment features of zoster and PHN are reviewed in this article. HZ is caused by renewed replication and spread of the varicella-zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age-related, disease-related, and drug-related decline in cellular immunity to VZV. VZV-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities in daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients. Comment by Miles Day, M.D. This article reviews the epidemiology clinical features diagnosis and treatment of acute herpes zoster. It also describes the treatment of postherpetic neuralgia. While this is a good review for the primary care physician, the discussion for the treatment for both acute herpes zoster and postherpetic neuralgia do not mention invasive therapy. It is well documented in pain literature that sympathetic blocks with local anesthetic and steroid as well as subcutaneous infiltration of active zoster lesions not only facilitate the healing of acute herpes zoster but also prevents or helps decrease the incidence of postherpetic neuralgia. All patients who present to the primary care physician with acute herpes zoster should have an immediate referral to a pain management physician for invasive therapy. The treatment of postherpetic neuralgia is a challenging experience both for the patient and the physician. While the treatments that have been discussed in this article are important, other treatments are also available. Regional nerve blocks including intercostal nerve blocks, root sleeve injections, and sympathetic blocks have been used in the past to treat postherpetic neuralgia. If these blocks are helpful, one can proceed with doing crynourlysis of the affected nerves or also radio-frequency lesioning. Spinal cord stimulation has also been used for those patients who are refractory to noninvasive and invasive therapy. While intrathecal methylprednisolone was shown to be effective in the study quoted in this article one must be cautious not to do multiple intrathecal steroid injections in these patients. Multilple intrathecal steroid injections can lead to archnoiditis secondary to the accumulation of the steroid on the nerve roots and in turn causing worsening pain. [source] Long-term results of the antegrade continent enema procedure for constipation in adultsCOLORECTAL DISEASE, Issue 5 2004N. P. Lees Abstract Objective The aim of this study was to evaluate the long-term results of the Antegrade Continent Enema (ACE) procedure for treating severe constipation in adults. Methods Over 10 years 37 ACE conduits were created in 32 patients (median age 35 years, 26 women) with constipation caused by slow transit, obstructed defaecation or both. Conduits were created from the appendix (n = 20, 54%), ileum (n = 10, 27%), neoappendix caecostomy (n = 5, 14%) or colon (n = 2, 5%). Clinical records were retrospectively reviewed to determine outcome. Results After a median follow up of 36 (range 13,140) months, 28 (88%) required at least one further procedure on a primary conduit, including reversal in 19 (59%). Five patients had a second conduit fashioned, two successfully. Conduit type and constipation cause did not significantly influence the rates of ACE reversal or major revision. Ileal conduits were associated with fewer minor revision procedures for stenosis (1 in 7 patients) than appendix conduits (21 in 20 patients). There was one (3%) serious complication. Satisfactory ACE function was ultimately achieved in 47% of patients, at last follow up. After ACE reversal, 9 (28%) patients underwent formation of an end stoma and 3 patients had a colectomy. Conclusions Revision procedures are common, but approximately half of patients can expect satisfactory long-term ACE function. ACE conduit reversal does not preclude subsequent alternative surgical strategies to treat this difficult condition. [source] ,Part of the family': sources of job satisfaction amongst a group of community-based dementia care workersHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2004Tony Ryan MA BSc Abstract The development of community-based services for people with dementia brings new challenges for health and social care providers, not least that of sustaining an enthusiastic workforce who are motivated to provide care and support under potentially isolating and difficult conditions. The present paper, based on interview data gathered from a group of community-based dementia care workers, seeks to identify their sources of job satisfaction and reward. Interviews were conducted with seven workers at two points in time and the data were analysed using a case by theme matrix approach. The results indicate that there were high levels of job satisfaction amongst the group, which were enhanced by several factors, including: good organisational support; day-to-day autonomy; the ability to maintain relationships with people with dementia and their families; and staffs' feelings of contributing to and improving the status and quality of life of people with dementia. Implications for workforce development are briefly considered. [source] Researching the reintegration of formerly abducted children in northern Uganda through action research: Experiences and reflectionsJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 3 2010Margaret Angucia Abstract This paper presents experiences and reflections on the use of a participatory research methodology under the difficult conditions of a war situation in northern Uganda. We draw from two complimentary approaches in action research to explain our methodology while doing research on the reintegration of formerly abducted children. First, the experience oriented approach, which emphasizes the need to articulate experience as a basis for learning and knowledge. Second, the exemplary participatory approach which highlights the importance of enhancing empowerment and the need to find solutions for social problems. We find these two approaches useful for doing action research in a conflict area because of their emphasis on experience and empowerment respectively. In our research, experience is important because of the children's encounter with the Lord's Resistance Army (LRA) rebels that both needs to be understood and justifies reintegration. On the otherhand, empowerment is important for our assumption that the children's experience and encounter with the LRA has disempowering effects on them. We demonstrate the use of the approaches in our research by enhancing participation, balancing power relations and being aware of ethical issues while at the same time attempting to make the research valid inspite of the challenges. Copyright © 2010 John Wiley & Sons, Ltd. [source] The Future of Japanese Manufacturing in the UKJOURNAL OF MANAGEMENT STUDIES, Issue 8 2002Glenn Morgan The expansion of Japanese FDI into the UK manufacturing sector during the 1980s and early 1990s gave rise to the debate on the Japanization of British industry. The paper argues that this debate was constructed from a Western perspective. It did not locate the strategies and structures of Japanese subsidiaries within the broader context of how Japanese multinational corporations were evolving in this period. The necessity to look at these issues from a more global perspective is reinforced by the changes which have occurred since the mid 1990s in the environment for Japanese multinationals. The global economy offers more choices to firms about their location as well as facing them with a more competitive environment. In the Japanese case, this is leading to a growing differentiation between standardized mass production (which can be located in Asia and Eastern Europe) and science,led sectors of industrial production (which necessitate location near to centres of research and development expertise in the USA and Europe). This means that Japanese firms are reconsidering the strategy and structure of their subsidiaries in the UK. Standardized mass production will only survive in the UK as long as costs can be pushed further down and productivity increased, both of which are difficult conditions to meet given possibilities elsewhere in the world for cheap mass production. The growing area of investment will be in science,based manufacturing, though here the UK will be competing against the USA and Germany for Japanese investment. Here, however, the organizational and management characteristics of Japanese subsidiaries will make the necessary connections with local managers and local networks of expertise difficult to achieve. Thus Japanese subsidiaries in the UK are in a period of prolonged uncertainty about their role in the future. These changes open up the necessity for a new agenda of research which goes beyond the Japanization approach and is concerned with the organization and management of Japanese multinationals in an era of global competition. [source] A comparison of the Glidescope® and Karl Storz DCI® videolaryngoscopes in a paediatric manikin,ANAESTHESIA, Issue 8 2010D. M. Hurford Summary A new paediatric Glidescope® (Cobalt GVL® Stat) has recently become available. This varies in design from the Karl Storz DCI® videolaryngoscope, as it possesses a short curved disposable blade compared with the narrower straighter blade of the Storz®. We compared the time taken for tracheal intubation under normal and difficult intubation conditions in a paediatric manikin. A total of 32 anaesthetists completed four intubations in a random order, with each participant blinded to the airway condition. We hypothesised there would be no difference between the devices. The results showed no difference in tracheal intubation time between the Glidescope and the Storz videolaryngoscope. The mean (SD) times under normal conditions were 18.8 (5.2) s vs 19.9 (6.1) s, (p = 0.16), respectively. Under difficult conditions the times were 22.6 (10.5) vs 27.0 (14.2) s, (p = 0.13), respectively. There were no differences in the visual analogue scores for field of view, ease of use, willingness to use in an emergency, and overall satisfaction. [source] | ||||||||||