JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2000
Siti Nurdjanah
Objective: To determine the gastric histopathological types distribution of H. pylori positive patients who were detected histopathologically. Material& Methods: Study design was prospective study. Consecutive patients who were suffering chronic dyspepsia underwent endoscopy examination between August 1998 and December 1999. The biopsy specimens were taken from gastric antrum and corpus and sent to the pathologist for histopathology type and H. pylori examinations. H. pylori were also confirmed with CLO and IgG-Helicobacter pylori tests. Results: There were 92 patients (48 male (M) and 44 Female (F) who underwent gastric biopsies endoscopically between August 1998 and December 1999. Fifty-six (60.87%) patients were chronic superficial gastritis, 11(11.96%) chronic antropic gastritis, 18 (19.56%) chronic gastritis 2 (2.17%) chronic gastritis with metaplasia, 3 (3.27%) gastric ulcer, and 2 (2.17%) gastric signet-ring cell carcinoma. Twenty one (22.8%) patients with H. pylori positive by histopathology examination with CLO and IgG-H.pylori tests. Those were 5 (8.90%) patients with chronic superficial gastritis, 7(63.63%) chronic atrophic gastritis, 3(100%) gastric ulcer, 2 (100%) chronic gastritis with metaplasia, 3(16.67%) chronic gastritis, 1(50%) signet-ring cell carcinoma. The age range of the H. pylori positive patients were between 16 and 76 years old. Conclusion: Twenty one (22.8%) H. pylori positive patients out of 92 endoscopied patients and the high percentage tendency of H. pylori positively in chronic atrophic gastritis, gastric ulcer, and chronic gastritis with metaplasia, although most of the patients had chronic superficial gastritis. Further study is needed with larger with larger sample to get the clearer picture of H. pylori distribution based on gastric histopathological types. [source]

ONE YEAR FOLLOWED-UP OF TREATMENT OF PRIMARY GLOMERULONEPHRITIS IN DR. CIPTO MANGUNKUSUMO HOSPITAL, JAKARTA

NEPHROLOGY, Issue 1 2002
Dharmeizar
[source]

15-YEAR AUDIT OF POST-TONSILLECTOMY HAEMORRHAGE AT DUNEDIN HOSPITAL

ANZ JOURNAL OF SURGERY, Issue 7 2007
Emily A. Macassey
Post-tonsillectomy haemorrhage is a significant complication because of its frequency and consequences. Increases in post-tonsillectomy haemorrhage prevalence have been reported. There is a controversy about whether increasing the use of diathermy techniques or anti-platelet aggregation effects of analgesia could have caused this increase. We carried out an audit of post-tonsillectomy haemorrhage and examined the rates of readmission for bleeding during the period 1990,2004. We also recorded the surgical technique used and the use of perioperative non-steroidal anti-inflammatory drugs and corticosteroids. During this period there has been a significant increase in post-tonsillectomy haemorrhage with an average annual increase of 15.3% (P < 0.0001, 95% confidence interval 8.5,22.5%). The increase is coincidental with the change-over to predominant diathermy technique and a routine use of postoperative non-steroidal anti-inflammatory drugs and steroids. [source]

GS12P MANAGEMENT OF UPPER GASTROINTESTINAL HAEMORRHAGE IN A DISTRICT HOSPITAL

ANZ JOURNAL OF SURGERY, Issue 2007
I. Dayoub
Background This study was conducted to assess the management of acute upper gastrointestinal bleeding in a district hospital and to compare these results with national guidelines and the published literature. Materials And Methods This prospective and retrospective study included 112 patients, mean age 66 years, who presented with acute upper gastrointestinal bleeding between July 2004 and February 2005. All patients were assigned a Rockall risk assessment score. Results The surgical on-call teams managed all the patients according to an agreed protocol. 49 patients had a Rockall score > or = 4. Endoscopy was performed in all patients, with 60% accomplished within the first 24 hours. The most common cause found was peptic ulcer (30%). Therapeutic endoscopy was undertaken in 10 patients (9%) with a success rate of 70%. Open surgery was performed in 3 patients. One patient died after having surgery and the Rockall score was >5. Of the patients admitted with acute upper gastrointestinal bleeding, 90.2% were discharged without complication. 11 patients died (9.8%) and all of them from the high risk group with Rockall scores >5. Their mean hospital stay was 17.8 days (range, 2,43 days). Conclusion High-standard results in acute upper gastrointestinal bleeding can be achieved in a district hospital. The management, including the use of the operating theatre facilities with operative and anaesthetic support, was safe and efficient. A 24-hour-a-day endoscopy service is important to achieve early diagnosis and to plan management. A protocol and early endoscopy improve clinical outcome and reduce mortality, which occurred mostly among elderly patients with high risk scores. It is advisable to introduce the Rockall scoring system in practice. [source]

SURGICAL MANAGEMENT OF BREAST CANCER IN A SMALL PERIPHERAL NEW ZEALAND HOSPITAL

ANZ JOURNAL OF SURGERY, Issue 12 2006
Don Wai Gin Lee
Background: Peripheral hospitals are perceived to be at a disadvantage in providing treatment for breast cancer, especially with regard to breast conservative surgery (BCS) because of the requirement of adjuvant radiotherapy. Wairau Hospital is a 100-bed peripheral hospital in New Zealand with no on-site radiotherapy unit. Methods: A retrospective audit of the surgical management of breast cancer between 1998 and 2002 was carried out. Results: One hundred and fifty-seven presentations during the audit period. Despite the lack of tertiary resources, we report an overall BCS rate of 58.6%, consistent with the appropriate New Zealand guidelines. Of screen-detected cancers, 81.6% underwent BCS. Only five patients requested mastectomy and of those undergoing BCS, five patients refused subsequent adjuvant radiotherapy. This was because of frailty from age and comorbidities and the inconvenience of travel. Conclusion: High rates of BCS are possible in peripheral hospitals. We postulate that intensive support and a visiting outpatient oncological service help empower patients to seek BCS if appropriate. A strong partnership between surgical, radiological and oncological services is also vital. [source]

ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR: A 7 YEAR EXPERIENCE AT THE LAUNCESTON GENERAL HOSPITAL

ANZ JOURNAL OF SURGERY, Issue 5 2005
Kate L. A. Borchard
Background: To review our 7 year experience of endovascular abdominal aortic aneurysm repair (EVR) and to compare this to open repair (OR) during the same time period. Methods: One hundred and one EVR and 65 OR patients were studied. Parameters analysed included patient and procedure details, intensive care unit (ICU) and hospital admission time, and morbidity and mortality with particular emphasis on procedure-related problems. Results: Endovascular grafts were deployed with successful abdominal aortic aneurysm (AAA) exclusion in 100 patients. Primary technical success was achieved in 84%, clinical success in 86% and secondary success in 90% of cases. Complications occurred in 63% and 88% of EVR and OR patients, respectively. Early device-related complications occurred in 40 EVR patients (40%); 24 (60%) were corrected immediately by further stenting. Late device-related complications occurred in 15 EVR patients (15%); four (27%) required additional stenting. Most of the complications in the OR group were systemic (89%) resulting in longer ICU and hospital stays (median 48 vs 17 h and 13 vs 4 days for OR and EVR, respectively). Death within 30 days of the procedure occurred in three EVR patients. There was no perioperative mortality in the OR group. Conclusion: Endovascular AAA repair can be undertaken successfully in a district general hospital. The majority of local and device-related complications can be corrected immediately, while those persisting beyond the initial procedure usually resolve spontaneously. EVR offers a minimally invasive approach to a problem that in the past has involved major surgery. [source]

ASSOCIATIONS BETWEEN AIR POLLUTION AND HOSPITAL VISITS FOR CARDIOVASCULAR DISEASES IN THE ELDERLY IN SYDNEY USING BAYESIAN STATISTICAL METHODS

AUSTRALIAN & NEW ZEALAND JOURNAL OF STATISTICS, Issue 3 2009
Hiep Duc
Summary Using generalized linear models (GLMs), Jalaludin,et al. (2006;,J. Exposure Analysis and Epidemiology,16, 225,237) studied the association between the daily number of visits to emergency departments for cardiovascular disease by the elderly (65+) and five measures of ambient air pollution. Bayesian methods provide an alternative approach to classical time series modelling and are starting to be more widely used. This paper considers Bayesian methods using the dataset used by Jalaludin,et al.,(2006), and compares the results from Bayesian methods with those obtained by Jalaludin,et al.,(2006) using GLM methods. [source]

THE PRIVATE FINANCING OF NHS HOSPITALS: POLITICS, POLICY AND PRACTICE

ECONOMIC AFFAIRS, Issue 1 2009
Mark Hellowell
This article outlines and critiques the main fiscal and economic rationales for the Private Finance Initiative and examines the impact of the policy on the long-term financial viability of NHS trusts. It concludes that the PFI funding of capital investment is highly problematic. Its high costs can have a negative impact on the finances of health systems. [source]

INTERVENTIONS FOR PREVENTING FALLS IN ACUTE AND CHRONIC CARE HOSPITALS: A SYSTEMATIC REVIEW AND META-ANALYSIS

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2008
Niloufar Hadidi APRN
No abstract is available for this article. [source]

CONFLICTS OF INTEREST ON THE BOARD OF DIRECTORS OF NON-PROFIT HOSPITALS: THEORY AND EVIDENCE

ANNALS OF PUBLIC AND COOPERATIVE ECONOMICS, Issue 3 2009
Keldon Bauer
ABSTRACT,:,Non-profit hospitals are overseen by a board of directors that is charged with representing the interests of the communities they serve. Theoretically, society is interested in maximizing both the quality and quantity of medical services available to it through the hospital. But other groups may also want to use the hospital to maximize their own wealth. This paper examines the effect of increasing the proportion of physicians on the board of directors. We show theoretically and empirically that with even one physician on the board, society's optimal quality/quantity vector is compromised. [source]

IN-HOSPITAL MORTALITY AFTER TRANSURETHRAL PROSTATECTOMY IN VICTORIAN HOSPITALS

ANZ JOURNAL OF SURGERY, Issue 5 2000
V. R. Marshall
No abstract is available for this article. [source]

REMOVING THE ROADBLOCKS TO MEDICAL AND HEALTH STUDENT TRAINING IN RURAL HOSPITALS IN VICTORIA

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2003
Graeme I. Jones
ABSTRACT Objective: To assess the extent of undergraduate health student placements in regional hospitals in northern Victoria in 1999, prior to substantial changes in rural undergraduate medical education in Australia. Method: Cross sectional postal survey with telephone follow-up in north-east Victoria. Subjects were all 17 regional and rural hospitals involved in health student teaching in North-east Victoria. Main outcome measures were the numbers, duration and discipline of health students placements and reported barriers to such placements. Results: Large regional hospitals accounted for two-thirds of all undergraduate health student placements. Smaller sites placed few allied health students. Barriers to a larger, more sustainable system of rural placements and rotations included accommodation shortages and funding constraints, particularly in smaller rural hospitals. Conclusions: Adequate resourcing of placements of a meaningful duration, stronger institutional support, and improved resourcing of regional accommodation is required to facilitate a larger, more systematic and sustainable system of medical and health student placements in rural areas. [source]

CULTURAL CIRCUMCISION IN EU PUBLIC HOSPITALS , AN ETHICAL DISCUSSION

BIOETHICS, Issue 8 2009
MARGHERITA BRUSA
ABSTRACT The paper explores the ethical aspects of introducing cultural circumcision of children into the EU public health system. We reject commonplace arguments against circumcision: considerations of good medical practice, justice, bodily integrity, autonomy and the analogy from female genital mutilation. From the unique structure of patient-medicine interaction, we argue that the incorporation of cultural circumcision into EU public health services is a kind of medicalization, which does not fit the ethos of universal healthcare. However, we support a utilitarian argument that finds hospital-based circumcision safer than non-medicalized alternatives. The argument concerning medicalization and the utilitarian argument both rely on preliminary empirical data, which depend on future validation. [source]

Etiologic spectrum and pattern of antimicrobial drug susceptibility in bacterial meningitis in Sokoto, Nigeria

ACTA PAEDIATRICA, Issue 8 2000
FE EmeleArticle first published online: 2 JAN 200
Etiologic agents of meningitis were prospectively investigated among patients admitted to Usman Danfodio University Teaching Hospital, Sokoto. Of 1097 cerebrospinal fluid (CSF) samples submitted to the microbiology laboratory from various wards of the hospital, 289 (26%) were microscopically, culturally and/or serologically proven to be bacterial meningitis. The etiologic spectrum was as follows: Neisseria meningitidis (61%), Streptococcus pneumoniae (18%), Haemophilus influenzae (10%), Staphylococcus aureus (6%), Coliform bacilli (3%), Escherichia coli (0.7%), Mycobacterium tuberculosis (0.7%), Listeria monocytogenes (0.4%), Flavobacterium meningosepticum (0.4%) and Pseudomonas putrifasciens (0.4%). Bacterial meningitis was most prevalent (195 or 68%) among children aged 1-9 y, while adults and neonates were least affected. Coliform bacilli caused five of eight neonatal cases. Males were more frequently affected than females (x2=12.50;p < 0.05). Culture and microscopy were comparatively less efficient than the search for bacterial antigens, especially in the diagnosis of Haemophilus meningitis. Antimicrobial susceptibility of N. meningitidis to ampicillin and benzyl penicillin reduced progressively over the years (F = 406.98;p < 0.001). Nineteen (11%) of the isolates (5 Meningococci, 7 Staph. aureus, 1 Haem. influenza and 6 others) showed simultaneous resistance to chloramphenicol, ampicillin and benzyl penicillin. [source]

Cost analysis of the treatment of acute childhood lymphocytic leukaemia according to Nordic protocols

ACTA PAEDIATRICA, Issue 4 2000
J Rahiala
Some attempts have been made to reduce the costs incurred in the therapy of leukaemia, but no studies are available regarding costs of the entire treatment in children with acute lymphocytic leukaemia (ALL). We analysed all the direct costs of treatment of 11 children with ALL diagnosed and treated in Kuopio University Hospital. The follow-up continued from diagnosis until the end of treatment for each patient. Patient treatment on the ward lasted for 84-210 d and in the outpatient clinic for 24-66 d, depending on the risk group. From 11-54 of the inpatient days were required for the treatment of infections. Total mean cost of the entire treatment was US $103 250 (US $55 196-166 039) per patient, 53% of which were basic hospital costs and 47% patient-specific costs. Laboratory tests and radiology accounted for 18% of all direct costs and cytostatic drugs for 13%, but blood products accounted for only 4% of the total. Infections were the most important extra cause of costs, accounting for 18% of the mean total costs per patient. The complete treatment of a child with ALL came to a total of US $103 250. However, since 80% of children with ALL are long-term survivors, the cost must be regarded as a good investment. [source]

Selective Application of the Pediatric Ross Procedure Minimizes Autograft Failure

CONGENITAL HEART DISEASE, Issue 6 2008
David L.S. Morales MD
ABSTRACT Objective., Pulmonary autograft aortic root replacement (Ross' operation) is now associated with low operative risk. Recent series suggest that patients with primary aortic insufficiency have diminished autograft durability and that patients with large discrepancies between pulmonary and aortic valve sizes have a low but consistent rate of mortality. Therefore, Ross' operation in these patients has been avoided when possible at Texas Children's Hospital. Our objective was to report outcomes of Ross' operation when selectively employed in pediatric patients with aortic valve disease. Methods., Between July 1996 and February 2006, 55 patients (mean age 6.8 ± 5.5 years) underwent Ross' procedure. Forty-seven patients (85%) had a primary diagnosis of aortic stenosis, three (5%) patients had congenital aortic insufficiency, and five (9%) patients had endocarditis. Forty-two (76%) patients had undergone prior aortic valve intervention (23 [55%] percutaneous balloon aortic valvotomies, 12 [29%] surgical aortic valvotomies, 12 [29%] aortic valve replacements, 2 [5%] aortic valve repairs). Fourteen (25%) patients had ,2 prior aortic valve interventions. Thirty-two patients (58%) had bicuspid aortic valves. Follow-up was 100% at a mean of 3 ± 2.5 years. Results., Hospital and 5-year survival were 100% and 98%, respectively. Morbidity included one reoperation (2%) for bleeding. Median length of hospital stay was 6 days (3 days,3 months). Six (11%) patients needed a right ventricular to pulmonary artery conduit exchange at a median time of 2.3 years. Freedom from moderate or severe neoaortic insufficiency at 6 years is 97%. Autograft reoperation rate secondary to aortic insufficiency or root dilation was 0%. Conclusions., By selectively employing Ross' procedure, outcomes of the Ross procedure in the pediatric population are associated with minimal autograft failure and mortality at mid-term follow-up. [source]

Geriatric Emergency Medicine and the 2006 Institute of Medicine Reports from the Committee on the Future of Emergency Care in the U.S. Health System

ACADEMIC EMERGENCY MEDICINE, Issue 12 2006
Scott T. Wilber MD
Abstract Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue. [source]

A survey of female patients in high security psychiatric care in Scotland

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2001
Dr Lindsay D.G. Thomson MD MPhil MRCPsych Senior Lecturer in Forensic Psychiatry Honorary Consultant Forensic Psychiatrist
Background The State Hospital, Carstairs, is the sole high security psychiatric facility for Scotland and Northern Ireland. Method This study compares the female (n = 28) and male (n = 213) patients resident there between 1992 and 1993 using data derived from case-note reviews and interviews with patients and staff. Results Nearly three-quarters of both the male and female populations had a primary diagnosis of schizophrenia, and secondary diagnoses of substance abuse and antisocial personality disorder were common. Female patients were more frequently admitted from other psychiatric hospitals, had less serious index offences and more minor previous convictions, and were less likely to be subject to a restriction order. They had more often experienced depressive symptoms and had significantly greater histories of self-harm, physical and sexual abuse. At interview, nearly three-quarters had active delusions and over half had recently behaved in an aggressive manner. Almost 90% were said not to require the security of the State Hospital. Conclusions It was concluded that mental illness and adverse social circumstances had combined to create a very disadvantaged group of women in high security psychiatric care in Scotland. As a group these women were inappropriately placed and their requirement was for intensive, rather than high security psychiatric care. Copyright © 2001 Whurr Publishers Ltd. [source]

Dental trauma that require fixation in a children's hospital

DENTAL TRAUMATOLOGY, Issue 1 2008
Timothy Bruns
Complex injuries to permanent teeth and their periodontium require immediate repositioning and stabilization. Many of these emergencies are treated by pediatric dental residents at the Women and Children's Hospital of Buffalo, Buffalo, New York. The purpose of this study was to characterize these complex injuries of permanent teeth that require emergency treatment in a Children's Hospital. All of the cases of dental trauma which had involved permanent teeth and which had been treated with a splint in 2001 and 2002 were reviewed. There were 79 patients that were between 5 and 19 years of age with twice as many males (54) as females (25). The number of males increased from childhood (5,10 years) to early adolescence (11,15 years) and then decreased rapidly in late adolescence (16,19 years), whereas the number of females decreased steadily with age. Most of the incidents occurred during the summer months (72%), particularly in June and July (42%), and Fridays and Saturdays were the busiest days of the week. Most of the injuries were caused by organized and recreational sporting activities (39%) and accidental falls (33%), followed by interpersonal violence (15%) and a few motor vehicle accidents (7%). The 173 permanent tooth injuries were mostly luxations (62%) or avulsions (20%), with only a few fractures of the alveolar bone (5%) or tooth root (1%). Most of the displacements were lateral luxations (40%) or extrusions (18%) with only a few intrusions (3%). These injuries most commonly afflicted the maxillary central incisors (54%), followed by the maxillary laterals (18%) and mandibular centrals (17%). The emergency treatment that was provided at the Children's Hospital included replantation and repositioning, and the placement of a semi-rigid or flexible splint. [source]

Factors affecting treatment outcomes following complicated crown fractures managed in primary and secondary care

DENTAL TRAUMATOLOGY, Issue 4 2006
N. G. Jackson
Abstract,,, The aims of this retrospective observational study were to determine the factors which affect treatment provision and the Median Survival Time (MST) for maintenance of tooth vitality following complicated crown fracture. The survey was carried out for patients treated at Newcastle Dental Hospital (NDH) according to departmental guidelines over a 2-year period following the introduction of a new protocol for management of these types of injuries. Seventy-three cases of complicated crown fracture were identified in 69 children with a mean age of 10.3 years (SD = 2.5 years). Seventy-one percent of the fractures occurred in males (M:F ratio was 2.5:1). Fifty-one percent of the complicated crown fractures were in immature teeth. Of the 73 traumatised teeth, 45% presented initially in general dental practice (GDP), 37% at the dental hospital and 8% at local accident and emergency departments with the remaining 10% seen at other or unrecorded locations. Of the 41 fractures, which presented initially at a location other than the dental hospital, 38% were referred to the dental hospital without the provision of an emergency pulp bandage. The overall definitive treatments provided for the 37 open apex teeth included pulp cap (19%), partial pulpotomy (32%), cervical pulpotomy (8%) and pulpectomy (35%), while for the 36 closed apex teeth it was pulp cap (28%), pulpotomy (11%), and pulpectomy (61%). Of the 30 teeth, which underwent vital pulp therapy (18 open and 12 closed apex), the MST for the 15 teeth treated with pulp caps was 1460 days (95% CI: 1067, 1853) while for the 15 teeth treated with pulpotomies it was 1375 days (95% CI: 964, 1786). There was no statistically significant difference in the MST between teeth treated with pulp caps and pulpotomies. In conclusion, the proportion of patients referred to secondary care with complicated crown fractures without provision of a pulp bandage is of some concern. More conservative treatment of closed apex teeth sustaining complicated crown fractures, utilizing vital pulp therapy techniques would appear to be appropriate. [source]

Phenol Chemical Matricectomy Is Less Painful, with Shorter Recovery Times but Higher Recurrence Rates, Than Surgical Matricectomy: A Patient's View

DERMATOLOGIC SURGERY, Issue 8 2010
JESSICA C. HASSEL DR MED
BACKGROUND Ingrown toenails have a tendency for recurrence. Operative interventions can be successful, and several procedures are in use. OBJECTIVE Retrospective evaluation, to reveal differences in postoperative pain, time to recovery, and satisfaction with the cosmetic outcome in patients treated with a phenol (PCM) or surgical matricectomy (SM). MATERIALS & METHODS All matricectomy patients at the Dermatology Department of the Ludwigshafen City Hospital between 2004 and 2008 were interviewed over the telephone. Of 72 evaluable patients with a total of 112 ingrown nail sides, 33 were treated with PCM and 39 with SM. The patient group consisted of 40.3% women, the median age was 31. RESULTS Patients after PCM indicated two points less postoperative pain on an analogue scale from 0 to 10 (p<.001). In the PCM group, more patients recovered from the operation in less than 1 week (p=.007). Patient evaluation of cosmetic outcome was not different between the groups (p=.76), but recurrence rates were significantly higher in the PCM group (31.5%, vs 6.9% in the SM group, p=.006) CONCLUSION Both matricectomies have advantages and disadvantages. We should discuss these issues with our patients to help them decide on the kind of matricectomy. The authors have indicated no significant interest with commercial supporters. [source]

Contribution of Dermatologic Surgery in War

DERMATOLOGIC SURGERY, Issue 1 2010
MAJOR J. SCOTT HENNING DO
BACKGROUND Despite the large contribution by dermatology to military readiness, there have been no published reports regarding dermatologic surgery or skin cancer in the combat environment. OBJECTIVE To outline the contribution of dermatologic surgery, including skin cancer and benign tumors, to deployed service men and women in Operation Iraqi Freedom. METHODS A retrospective chart review was performed of all dermatology visits at the 86th Combat Support Hospital, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008. RESULTS Two thousand six hundred ninety-six patients were seen in the combat dermatology clinic during the 6-month period reviewed; 8% (205/2,696) of the total visits were for skin cancer, and another 129 patients were treated for actinic keratosis. The specific diagnoses were basal cell carcinoma (n=70), in situ and invasive squamous cell carcinoma (n=68), mycosis fungoides (n=1), bowenoid papulosis (n=1), and in situ and invasive melanoma (n=9). Benign lesions and tumors accounted for 14% (357/2,696) of total patient visits. Three hundred seven surgeries were performed during the 6-month period (178 skin cancers and 129 benign lesions), and 20 patients were referred for Mohs micrographic surgery. The surgical complications included five postoperative wound infections (1 methicillin-resistant Staphylococcus aureus), one wound dehiscence, and seven allergic contact dermatitis. CONCLUSIONS To the authors' knowledge, this is the first publication regarding skin cancer and dermatologic surgery in the combat setting. This report outlines the important contribution of dermatologic surgery in the combat environment. The authors have indicated no significant interest with commercial supporters. [source]

Lactic Acid Chemical Peels as a New Therapeutic Modality in Melasma in Comparison to Jessner's Solution Chemical Peels

DERMATOLOGIC SURGERY, Issue 12 2006
KHALIFA E. SHARQUIE MBCHB
BACKGROUND Many chemicals have been used in the skin peeling for melasma such as Jessner's solution and glycolic acid. Lactic acid is an ,-hydroxy acid that has not been used before in chemical peeling of melasma. OBJECTIVE The purpose of the present work was to evaluate the efficacy and safety of lactic acid in chemical peeling of melasma in comparison to Jessner's solution chemical peels. METHODS This study was conducted at the Department of Dermatology and Venereology, Baghdad Hospital, in the period between April 2001 and August 2002. Thirty patients with melasma were included in this study. They were mostly of skin type IV according to Fitzpatrick's classification, 26 (86.67%) were women, and 4 (13.33%) were men, with an age range from 18 and 50 years (mean±SD, 33.53±6.96 years). Full clinical examination was done to all patients including Wood's light. The severity of melasma was assessed by MASI (Melasma Area Severity Index). Pure lactic acid full strength (92%, pH 3.5) was used as a new peeling agent on the left side of the face while Jessner's solution was applied to the right side of the face. The chemical peeling sessions were done every 3 weeks until the desired response was achieved. Follow-up was carried out for 6 months after the last session. RESULTS Six patients were defaulted from the study after the first session for unknown reasons. Twenty-four patients completed the study. Twenty (83.33%) were women and four were men (16.67%). Wood's light examination showed increased contrast in all patients of mostly epidermal melasma. The number of sessions ranged from 2 to 5. All patients showed marked improvement as calculated by MASI score before and after treatment, and the response was highly statistically significant. No side effect was recorded in all treated patients. CONCLUSION Lactic acid was found to be an effective and safe peeling agent in the treatment of melasma, and it was as effective as Jessner's solution. [source]

Role of Intralesional Bleomycin in the Treatment of Complicated Hemangiomas: Prospective Clinical Study

DERMATOLOGIC SURGERY, Issue 5 2005
Shapour Omidvari MD
background. Hemangioma is the most common tumor of infancy. Although it has a basically benign nature and usually spontaneously regresses, a small percentage (5%) have complications that need treatment. Many different therapeutic modalities can be used in this tumor. objective. To investigate the effect of a new method of treatment (intralesional bleomycin injection) in complicated hemangiomas. materials and methods. In the Department of Radiation Oncology at Nemazee Hospital in Shiraz, Iran, from April 1992 to October 1998, 32 patients with complicated hemangioma were treated with four to six courses of direct injection of bleomycin into the lesion. results After a minimum follow-up of 6 years, there was 70 to 100% regression in 18 patients, 50 to 70% in 7 cases, and less than 50% reduction in 7 patients. conclusion. Intralesional injection of bleomycin is an easy, safe, and effective therapeutic modality in complicated cutaneous hemangiomas. [source]

Treatment 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 Study

DERMATOLOGIC SURGERY, Issue 8 2002
Leyda 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]

CHALLENGES FACED BY RESEARCH ETHICS COMMITTEES IN EL SALVADOR: RESULTS FROM A FOCUS GROUP STUDY

DEVELOPING WORLD BIOETHICS, Issue 1 2009
JONATHAN W. CAMP
ABSTRACT Objective:, To identify perceived barriers to capacity building for local research ethics oversight in El Salvador, and to set an agenda for international collaborative capacity building. Methods:, Focus groups were formed in El Salvador which included 17 local clinical investigators and members of newly formed research ethics committees. Information about the proposed research was presented to participants during an international bioethics colloquium sponsored and organized by the St. Jude Children's Research Hospital in collaboration with the National Ethics Committee of El Salvador and the University of El Salvador. Interviews with the focus group participants were qualitatively analyzed. Results:, Participants expressed the need to tailor the informed consent process and documentation to the local culture; for example, allowing family members to participate in decision-making, and employing shorter consent forms. Participants indicated that economic barriers often impede efforts in local capacity building. Participants valued international collaboration for mutual capacity building in research ethics oversight. Conclusions:, Research ethics committees in El Salvador possess a basic knowledge of locally relevant ethical principles, though they need more training to optimize the application of bioethical principles and models to their particular contexts. Challenges increase the value of collaborative exchanges with ethics committee members in the United States. Further research on facilitating communication between host country and sponsor country ethics committees can maximize local research ethics expertise, and thus raise the standard of protecting human participants involved in international research. [source]

Gastrostomy placement in paediatric patients with neuromuscular disorders: indications and outcome

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2007
Gian Paolo Ramelli MD
Studies of children with neurodevelopmental disorders have shown that receiving nutrition through a gastrostomy can improve clinical outcomes and quality of life. However, there is little information on gastrostomy and its effect in patients with neuromuscular disorders. A retrospective casenote review of all patients with a gastrostomy, followed-up at the Hammersmith Hospital, London, was undertaken to assess the indications for, and outcomes of, gastrostomy placement. Notes for 32 patients (17 males, 15 females) were reviewed (age range 32mo,31y; median age 12y 5mo). We found three main groups of diagnoses: congenital muscular dystrophy (n=15), structural congenital myopathies (n=11), and other neuromuscular disorders (n=6). Two main patterns of feeding problems were identified before gastrostomy: swallowing difficulties, and nutrition and growth problems. The follow-up period after gastrostomy was from 12 months to 19 years (mean 5y). Weight faltering was reversed in 17 out of 22 patients, and height faltering in 9 out of 14, where data were available. Twenty-six patients had a reduced frequency of chest infections. No significant complication of gastrostomy placement was documented. Twenty-eight patients or their families were happy with the results of the gastrostomy. Gastrostomy seems to have a substantial positive impact in patients with neuromuscular disease and feeding difficulties. [source]

Long-term use of the ketogenic diet in the treatment of epilepsy

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2006
Darcy K Groesbeck BS
Long-term outcomes of the ketogenic diet in the treatment of epilepsy have not previously been reported. A retrospective chart review of children treated with the ketogenic diet for more than 6 years at the Johns Hopkins Hospital was performed. The response was documented at clinic visits and by telephone contacts; laboratory studies were obtained approximately every 6 to 12 months. Satisfaction and tolerability were assessed by means of a brief parental telephone questionnaire. In all, 28 patients (15 males, 13 females), currently aged 7 to 23 years, were identified. The median baseline seizure frequency per week at diet onset was 630 (range 1,1400). Diet duration ranged from 6 to 12 years; 19 remain on the diet currently. After 6 years or more, 24 children experienced a more than 90% decrease in seizures, and 22 parents reported satisfaction with the diet's efficacy. Ten children were at less than the 10th centile for height at diet initiation; this number increased to 23 at the most recent follow-up (p=0.001). Kidney stones occurred in seven children and skeletal fractures in six. After 6 years or more the mean cholesterol level was 201mg/dl, high-density lipoprotein was 54mg/dl, low-density lipoprotein was 129mg/dl, and triglycerides were 97mg/dl. Efficacy and overall tolerability for children are maintained after prolonged use of the ketogenic diet. However, side effects, such as slowed growth, kidney stones, and fractures, should be monitored closely. [source]