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Medical Sciences	75%

Selected Abstracts

Variable-Pulse Nd:YAG Laser in the Treatment of Facial Telangiectasias

DERMATOLOGIC SURGERY, Issue 1 2006
AVERY A. BEVIN MD
BACKGROUND Variable-pulse 1,064 nm wavelength lasers have been used with good effectiveness on leg telangiectasias and reticular veins and have shown promising results on facial telangiectasias as well. OBJECTIVE To investigate the effectiveness of a variable-pulse neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using a small spot size in the treatment of facial telangi-ectasias. METHODS Eight male patients (mean age 75 years) underwent a single treatment session using a variable-pulse 1.5 mm spot size Nd:YAG laser with epidermal cooling. Telangiectasia diameters were 0.3 to 2.0 mm. Test sites were performed using three pulse widths (3, 20, and 60 ms), with fluences varying depending on vessel size and response. Full treatments were per-formed using test parameters giving the best response. Thirteen weeks later, the patients returned for final evaluation and satisfaction rating. RESULTS Fluences ranged from 226 to 425 J/cm2, with smaller vessels requiring larger energies. Pulse duration was equally divided between the 20 and 60 ms settings. The shortest pulse width (3 ms) was inferior in all patients. Longer pulse durations achieved superior vessel elimination with minimal immediate purpura and no postinammatory hyperpigmentation. The average mean vessel clearance was 26 to 50% in half of the patients and 51 to 75% in the other half as evaluated by three unbiased dermatologists with extensive laser experience. CONCLUSION A small,spot size Nd:YAG laser using a pulse width of 20 ms or higher appears to be effective in clearing a significant percentage of facial telangectasias with a single pass. The side effects were minimal. [source]

Spin densities in two-component relativistic density functional calculations: Noncollinear versus collinear approach

JOURNAL OF COMPUTATIONAL CHEMISTRY, Issue 8 2002
Christoph Van WüllenArticle first published online: 3 APR 200
Abstract With present day exchange-correlation functionals, accurate results in nonrelativistic open shell density functional calculations can only be obtained if one uses functionals that do not only depend on the electron density but also on the spin density. We consider the common case where such functionals are applied in relativistic density functional calculations. In scalar-relativistic calculations, the spin density can be defined conventionally, but if spin-orbit coupling is taken into account, spin is no longer a good quantum number and it is not clear what the "spin density" is. In many applications, a fixed quantization axis is used to define the spin density ("collinear approach"), but one can also use the length of the local spin magnetization vector without any reference to an external axis ("noncollinear approach"). These two possibilities are compared in this work both by formal analysis and numerical experiments. It is shown that the (nonrelativistic) exchange-correlation functional should be invariant with respect to rotations in spin space, and this only holds for the noncollinear approach. Total energies of open shell species are higher in the collinear approach because less exchange energy is assigned to a given Kohn-Sham reference function. More importantly, the collinear approach breaks rotational symmetry, that is, in molecular calculations one may find different energies for different orientations of the molecule. Data for the first ionization potentials of Tl, Pb, element 113, and element 114, and for the orientation dependence of the total energy of I and PbF indicate that the error introduced by the collinear approximation is ,0.1 eV for valence ionization potentials, but can be much larger if highly ionized open shell states are considered. Rotational invariance is broken by the same amount. This clearly indicates that the collinear approach should not be used, as the full treatment is easily implemented and does not introduce much more computational effort. © 2002 Wiley Periodicals, Inc. J Comput Chem 23: 779,785, 2002 [source]

How do anaesthesiologists treat malignant hyperthermia in a full-scale anaesthesia simulator?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2001
T. i Gardi
Background: Clinical malignant hyperthermia (MH) is rare and usually occurs unexpectedly. Prompt diagnosis and correct treatment is crucial for survival of the patient developing fulminant MH. The aims of the present study were to investigate whether anaesthesiologists could make a correct diagnosis of MH and to evaluate their treatment of fulminant MH in a simulator. Methods: Thirty-two teams (one anaesthesiologist/one nurse anaesthetist) were exposed to an event of clinical MH in a full-scale simulator. Their performance was videotaped for retrospective analysis of the treatment on the basis of the recommendations of the Danish Malignant Hyperthermia Register. Results: All 32 teams asked the surgeon to terminate the surgery as fast as possible, switched off the vaporiser and administered 100% oxygen. Although all intended to hyperventilate the patient, only 14 teams actually managed to perform the hyperventilation. Most problems were found in teams that switched to manual ventilation. All teams treated the patient with dantrolene, and symptomatic treatment was initiated by all even though some elements of the full treatment were lacking, possibly due to the limited time available. Conclusion: All teams diagnosed MH in the simulator satisfactorily. The surprising negative finding was that more than half of the participants failed to hyperventilate the "patient" although they intended to do so. This investigation shows that the problem in these teams' treatment of MH was more a question of practical management of the resources than lack of theoretical knowledge. [source]

Advance directives and emergency department patients: ownership rates and perceptions of use

INTERNAL MEDICINE JOURNAL, Issue 12 2003
D. McD.
Abstract Background: Advance directives (ADs) are rarely available in Australia to guide management but may become more important as our population ages. Aims: The present study aimed to determine patient knowledge, perception and ownership rates of ADs and the factors that impact upon these variables. Methods: A cross-sectional survey of emergency department patients was undertaken. The main outcome measures were: (i) prior discussion about the extent of medical treatment and ADs, (ii) knowledge and perceptions of ADs, (iii) present AD ownership rates and (iv) likelihood of future AD ownership. Generalized linear models were used for analysis. Results: Four hundred and three patients were enrolled. The mean age of patients was 73 years and 239 (59.3%) were male. Two hundred and forty patients (59.6%) had discussed the extent of treatment. Only 81 patients (20.1%) had discussed the use of an AD. One hundred and thirty-seven patients (34.0%) knew of one type of AD and 333 patients (82.6%) thought some ADs were a good idea. Only 32 patients (7.9%) owned an AD, although 276 (68.5%) would consider owning one. The main reason for never obtaining an AD was ,always wanting full treatment' (93 patients, 23.1%). Level of education was the only characteristic that impacted significantly upon an outcome measure. Patients with a higher level of education were more likely to have known and spoken about ADs, to own an AD and to consider owning one. Conclusions: AD knowledge and ownership rates were low. However, most patients perceive them favourably and many would consider owning one. Intervention strategies to improve AD awareness are indicated. This may empower patients to more effectively participate in their own advance care planning. (Intern Med J 2003; 33: 586,592) [source]