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]

Rhythm Management in Pediatric Heart Failure

CONGENITAL HEART DISEASE, Issue 4 2006
Charles I. Berul MD
ABSTRACT There are several options now available for the management of arrhythmias and ventricular dysfunction in pediatric patients with heart failure. A hybrid approach that combines the expertise of heart failure and electrophysiology specialists may be well suited for the optimal management of these complex patients. Medical and device therapies may be synergistic in decreasing the morbidity and mortality in pediatric heart failure. Pediatric electrophysiology can now potentially offer therapies that can help prevent both arrhythmic and pump failure deaths, as well as improve functional capacity and quality of life. These therapies and the available supporting data relevant to pediatrics will be the focus of this review. [source]

Relationship of illness perceptions with depression among individuals diagnosed with lupus,

DEPRESSION AND ANXIETY, Issue 6 2009
Errol J. Philip M.A
Abstract Background: The purpose of this study was to investigate the relationship of illness perceptions, as outlined in the Self-Regulatory Model of illness, with depression among individuals diagnosed with lupus. Methods: A mail-out questionnaire was completed by 154 members of the Australia Lupus Foundation and Lupus Foundation of New South Wales. Each questionnaire consisted of a Lupus Medical and Symptoms Questionnaire, the Illness Perceptions Questionnaire-Revised and the Cardiac Depression Scale. Results: Hierarchical regression analysis revealed that individuals who reported a perception of their illness as having negative life consequences, an unpredictable nature and themselves possessing little understanding of lupus, reported high levels of depression. Conclusions: This study indicated the existence of a high level of depressive symptoms among individuals diagnosed with lupus, and reinforces the need for screening procedures in chronic illness, and treatment interventions that target maladaptive illness perceptions. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]

Sclerotherapy of Varicose Veins with Polidocanol Based on the Guidelines of the German Society of Phlebology

DERMATOLOGIC SURGERY, Issue 2010
EBERHARD RABE MD
BACKGROUND Sclerotherapy involves the injection of a sclerosing agent for the elimination of intracutaneous, subcutaneous, and transfascial varicose veins. OBJECTIVE To update guidelines for sclerotherapy of varicose veins. METHODS The guidelines for sclerotherapy of varicose veins of the German Society of Phlebology were updated and modified through a review of the available literature. RESULTS Published clinical series and controlled clinical trials provide evidence to support the elimination of intracutaneous and subcutaneous varicose veins using sclerotherapy. Allergic skin reactions occur occasionally as allergic dermatitis, contact urticaria, or erythema. Anaphylaxis is rare. Transient migraine headaches present more frequently in patients treated with foam sclerotherapy than liquid sclerotherapy. CONCLUSION Sclerotherapy is the method of choice for the treatment of small-caliber varicose veins (reticular varicose veins, spider veins). If performed properly, sclerotherapy is an efficient treatment method with a low incidence of complications. BioForm Medical provided financial support for formal formatting of this manuscript without any influence over the content of the manuscript. The authors have previously participated in two scientific studies with polidocanol (ESAF and EASI study) financed by Kreussler. [source]

Idiopathic Hemifacial Atrophy Treated with Serial Injections of Calcium Hydroxylapatite

DERMATOLOGIC SURGERY, Issue 4 2010
SUE ELLEN COX MD
Bioform Medical provided the materials used in this study [source]

Idiopathic Circumscripta Calcinosis Cutis of the Knee

DERMATOLOGIC SURGERY, Issue 12 2003
FACS, Luigi Valdatta MD
Background. Calcinosis cutis, a disease characterized by the presence of calcium deposits in the skin, is classified into four types according to etiology: dystrophic, metastatic, iatrogenic and idiopathic. The dystrophic form is the most common while the idiopathic one is the rarest, but specific incidence and frequency data are not available in scientific literature. Objective. Calcinosis cutis circumscripta is a very rare form of idiopathic calcinosis cutis arising in the second half of life. It typically involves the extremities and is associated with prior trauma and scleroderma. We dealt with a very rare form of calcinosis cutis circumscripta in a healthy patient, for whom surgical excision revealed to be an effective and successful treatment. Methods and materials. We present the case of a 46-year-old woman affected by idiopathic circumscripta calcinosis cutis of the left knee, successfully treated by surgical removal. Discussion. Medical and surgical treatment are options to cure calcinosis cutis. Medical therapy is not very effective. Surgical excision has shown to be beneficial, as it can provide a symptomatic relief. However, since calcinosis cutis limits are not always well defined a recurrence of the lesions may occur. [source]

Hand augmentation with Radiesse® (Calcium hydroxylapatite)

DERMATOLOGIC THERAPY, Issue 6 2007
Mariano Busso
ABSTRACT:, The hand has remained a considerable treatment challenge, as new soft tissue fillers have arrived in the esthetic marketplace. The challenge has been the result of both the multiple visits required for treatment in, for example, autologous fat grafting and the simple management of pain in the innervated areas of the hand between the bones. This paper introduces a novel, noticeably less painful approach to treatment of the hand with calcium hydroxylapatite (CaHA; Radiesse®, BioForm Medical, San Mateo, CA). Anesthetic is added to the compound prior to injection, resulting in a homogenous admixture of CaHA and anesthetic. A bolus of the mixture is injected into the skin, using tenting, and then spread throughout the hand. The result of this approach , mixing anesthetic with CaHA , is treatment that is easier to massage and disseminate, less painful to the patient than conventional hand injection, and characterized by less swelling and bruising, with minimal post-treatment downtime. [source]

Medical and surgical therapies for alopecias in black women

DERMATOLOGIC THERAPY, Issue 2 2004
Valerie D. Callender
ABSTRACT:, Hair loss is a common problem that challenges the patient and clinician with a host of cosmetic, psychological and medical issues. Alopecia occurs in both men and women, and in all racial and ethnic populations, but the etiology varies considerably from group to group. In black women, many forms of alopecia are associated with hair-care practices (e.g., traction alopecia, trichorrhexis nodosa, and central centrifugal cicatricial alopecia). The use of thermal or chemical hair straightening, and hair braiding or weaving are examples of styling techniques that place African American women at high risk for various "traumatic" alopecias. Although the exact cause of these alopecias is unknown, a multifactorial etiology including both genetic and environmental factors is suspected. A careful history and physical examination, together with an acute sensitivity to the patient's perceptions (e.g., self-esteem and social problems), are critical in determining the best therapy course. Therapeutic options for these patients range from alteration of current hair grooming practices or products, to use of specific medical treatments, to hair replacement surgery. Since early intervention is often a key to preventing irreversible alopecia, the purpose of the present article is to educate the dermatologist on all aspects of therapy for hair loss in black women,including not only a discussion of the main medical and surgical therapies but also an overview of ethnic hair cosmetics, specific suggestions for alterations of hair-care practices, and recommendations for patient education and compliance. [source]

Perceived need for emergency medicine training in Pakistan: A survey of medical education leadership

EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2009
Junaid A Razzak
Abstract Objective: To assess the perception of leaders of the academic medical institutions regarding the need for specialty training in emergency medicine. Methods: A cross-sectional survey was conducted in all medical colleges of Pakistan in September 2005. Our sample included all academic leaders of recognized medical colleges in Pakistan. A questionnaire was designed and sent (mailed and faxed) to vice chancellors, deans, principals or medical directors of the institutions. Reminders were sent through faxes and emails wherever available, followed by phone calls if responses were not available after several attempts. Results: At the time of study, there were 39 medical colleges recognized by Pakistan Medical and Dental Council. Of these, responses were received from 26 teaching institutions in the country. A majority of the respondents (85%) were not satisfied with the care provided in the ED of their primary teaching hospital, and three-fourth (74%) thought that doctors specialized in other disciplines, like internal medicine and family medicine, cannot adequately manage all emergencies. When asked if Pakistan should have a separate residency training programme in emergency medicine, 96% responded in affirmative, and many (85%) thought that they will start a residency programme in emergency medicine if it was approved as a separate specialty. Conclusion: This survey shows significant support for a separate local training programme for emergency medicine in the country. [source]

Medical and veterinary entomology; Forensic entomology

ENTOMOLOGICAL RESEARCH, Issue 2007
Article first published online: 7 AUG 200
First page of article [source]

A breath test to assess compliance with disulfiram

ADDICTION, Issue 12 2006
Keron Fletcher
ABSTRACT Aims To evaluate the ability of a hand-held breath analyser, the Zenalyser® (Zenics Medical), to identify alcohol-dependent patients receiving disulfiram therapy and to assess the sensitivity and specificity of the instrument at different time intervals post-disulfiram dosing. Design Breath samples were taken from two groups of alcohol-dependent patients, one group on a daily disulfiram regimen and one group receiving no disulfiram. The breath samples were analysed for the combined concentration of carbon disulphide and acetone produced from the metabolism of disulfiram. From these data, two reference ranges were prepared and used for sensitivity and specificity assessments. Setting Breath samples for the reference ranges were obtained from patients at Shelton Hospital, Shrewsbury. Breath samples used to assess the sensitivity and specificity of the instrument were obtained from patients at the Edinburgh Alcohol Problems Clinic. Participants Twenty in-patients from Shelton Hospital receiving a daily 200 mg disulfiram regimen and 20 in-patients receiving no disulfiram. At the Edinburgh Clinic, 54 patients taking a thrice-weekly disulfiram regimen and 22 patients not on disulfiram. Measurements A total of 489 breath samples from Shelton Hospital and 391 breath samples from the Edinburgh Clinic were analysed for the combined concentrations of carbon disulphide and acetone. Findings The breath analyser produced results that distinguished between the disulfiram-treated and untreated groups (P < 0.001). At 1 day post-dose, the sensitivity was 100% and the specificity was 100%. At 2 and 3 days post-dose, the sensitivities and specificities were 84.6% and 100% and 88.2% and 100%, respectively. Conclusion The breath analyser can improve the assessment of the compliance status of patients receiving a daily dose regimen of disulfiram, but is less useful for this purpose if disulfiram is taken on a thrice-weekly regimen. [source]

Equine recurrent uveitis: A clinical manifestation of leptospirosis

EQUINE VETERINARY EDUCATION, Issue 10 2009
L. Frellstedt
Summary Leptospirosis is a zoonosis of worldwide distribution affecting domestic animals, wildlife and man. The bacterial disease is caused by pathogenic Leptospira spp., which are transmitted from reservoir hosts to accidental hosts. Horses are accidental hosts and can become susceptible to leptospiral infections. Widespread exposure to leptospires exists and is significantly more common than clinical disease. Leptospirosis can have different clinical manifestations including abortion, still birth, systemic disease with hepatic or renal dysfunction, and equine recurrent uveitis (ERU). ERU is the most frequently encountered clinical manifestation and this article will focus on the review of leptospira-associated ERU. Equine recurrent uveitis is the most common cause of vision impairment and blindness in horses. The pathogenesis of leptospira-associated ERU involves direct bacterial effects and immune-mediated responses. Clinical signs vary between the acute and chronic phases of the disease and progress over time. The diagnosis of leptospira-associated ERU can be difficult and usually requires a combination of diagnostic tests. Medical and surgical treatments have been described with varying outcomes. The prognosis for sight is usually poor, although core vitrectomy may improve the outcome. Avoidance of leptospiral exposure of horses is the only reliable prevention of leptospira-associated disease. [source]

Effect of daytime, weekday and year of admission on outcome in acute ischaemic stroke patients treated with thrombolytic therapy

EUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2010
M. Jauss
Background:, Since doubts were raised, if a challenging medical procedure such as acute stroke treatment including thrombolysis with recombinant tissue plasminogen activator (rTPA) is available with identical standard and outcome 24 h and 7 days a week our aim was to examine if acute stroke patients defined by onset-admission time (OAT) of , 3 h were treated differently or had distinct outcome when admitted during off duty hours (day versus night and weekend versus weekdays) and if any differences in treatment or outcome were apparent when comparing patients admitted in the year 2003 with patients admitted in the year 2006. Methods:, We analyzed 2003,2006 data of a prospective registry and grouped patients by time, day, and year of admission. The evaluation was limited to patients that were diagnosed with ischaemic stroke and with OAT of , 3 h. Medical and sociodemographic items, use of thrombolytic treatment, complications during clinical course and place of discharge were obtained. Clinical state on admission and discharge was assessed using the modified Rankin scale. Comparison with chi-square test, t -test and logistic regression was performed. Results:, Patient's characteristics, rate of thrombolysis, and outcome were independent from time or day of admission. Proportion of patients with good clinical state at discharge increased significantly from 2003 to 2006 together with a higher rate of rTPA treatment without increase of intracranial hemorrhage. Proportion of patients discharged in good clinical condition after rTPA treatment increased from 34% to 44%. Conclusions:, Stroke treatment in potential candidates for thrombolytic therapy revealed no impairment on weekend or at night already in 2003. During 4 years, it was possible to increase rate of rTPA treatment from 8.9% to 21.8% without increment of complications or death, confirming that rTPA is safe and can be implemented with full daily and weekly coverage. [source]

Functional electrical stimulation in neurological disorders

EUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2008
O. K. Sujith
Functional electrical stimulation (FES) refers to electrical stimulation of muscles in order to improve the impaired motor function. This is achieved by activating skeletal muscles with constant frequency trains of stimulations. This method has been found useful in various neurological disorders like hemiplegia, foot drop and paraplegia including spinal cord injuries. The first half of this review focuses on the broad clinical applications of functional electrical stimulation, its mechanism of action and the complications of this mode of therapy. Advanced Parkinson's disease (PD) is characterized by marked slowing of gait and frequent freezing episodes. Medical and surgical treatments are often ineffective in managing freezing episodes. The second half of this review discusses briefly the gait abnormalities in PD and the available treatment options. The possible role of FES in improving gait in parkinsonism and the importance of future research in this direction are highlighted. [source]

Second Life: an overview of the potential of 3-D virtual worlds in medical and health education

HEALTH INFORMATION & LIBRARIES JOURNAL, Issue 4 2007
Maged N. Kamel Boulos
This hybrid review-case study introduces three-dimensional (3-D) virtual worlds and their educational potential to medical/health librarians and educators. Second life (http://secondlife.com/) is perhaps the most popular virtual world platform in use today, with an emphasis on social interaction. We describe some medical and health education examples from Second Life, including Second Life Medical and Consumer Health Libraries (Healthinfo Island,funded by a grant from the US National Library of Medicine), and VNEC (Virtual Neurological Education Centre,developed at the University of Plymouth, UK), which we present as two detailed ,case studies'. The pedagogical potentials of Second Life are then discussed, as well as some issues and challenges related to the use of virtual worlds. We have also compiled an up-to-date resource page (http://healthcybermap.org/sl.htm), with additional online material and pointers to support and extend this study. [source]

Cerebro- and cardiovascular conditions in adults with schizophrenia treated with antipsychotic medications

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 6 2007
Jeanette M. Jerrell
Abstract Objective To report on the relative risk of cerebro- and cardiovascular disorders associated with antipsychotic treatment among adults with schizophrenia. Method Medical and pharmacy claims data from the South Carolina Medicaid program were extracted to compare the prevalence rates for four coded cerebrovascular (cerebrovascular disease; cerebrovascular accident; cerebrovascular hemorrhage; and peripheral vascular disease) and four cardiovascular (myocardial infarction; ischemic heart disease; arrhythmias; and cardiomyopathy) conditions. The analysis employed a retrospective cohort design with a 3 years time period as the interval of interest. Schizophrenic adults (18,54) (n,=,2251) prescribed one of six atypical or two conventional antipsychotic medications were identified and comprised the analysis set. Results Incidence rates for cerebrovascular disorders ranged from 0.5 to 3.6%. No significant association between antipsychotic usage and cerebrovascular disorders was noted largely due to the low base rate. Incidence rates for overall cardiovascular conditions ranged from 6 to 20%. The odds of developing cardiomyopathy were significantly lower for aripiprazole (OR,=,,3.45; p,=,0.02), while the odds of developing hypertension were significantly lower for males (OR,=,,1.37; p,=,0.009) but significantly higher for patients prescribed ziprasidone (OR,=,1.91; p,=,0.01) relative to conventional antipsychotics. Conclusion No significant association between antipsychotic usage and cerebro- or cardiovascular disorders was noted. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Mental health in infants with esophageal atresia,

INFANT MENTAL HEALTH JOURNAL, Issue 1 2009
Anne Faugli
Chronic somatic illness in infancy may challenge the development of mental health and impinge the infant's capability to form close interpersonal relationships. Esophageal atresia (EA) is a congenital anomaly requiring neonatal surgery, medical aftertreatment, and extended hospitalization. The aim of the study was to assess mental health and to find prognostic factors for mental health among infants with EA. Thirty-nine infants treated consecutively during 2000 to 2003 and their mothers were included. Infant mental health was assessed by Diagnostic Classification: 0,3 (Zero to Three, 1994). Medical and environmental data were collected from medical records and semistructured interview with the mothers. Child development was assessed with the Bayley scales, second edition (N. Bayley, 1993). Maternal psychological distress, anxiety, and child temperament were assessed by self-report questionnaires: the General Health Questionnaire, 30-item version (D. Goldberg & P. Williams, 1988); the State Trait Anxiety Inventory (C.D. Spielberger, R. Gorsuch, & R. Lushene, 1970); and the Infant Behaviour Questionnaire (M.K. Rothbart, 1981). Thirty-one percent of the infants with EA showed mental health disorders by 1 year of age. Prognostic factors predicting mental health were posttraumatic symptoms reported by mother, more than one operation, mechanical ventilation beyond 1 day, and moderate/severe chronic family strain. Relational trauma, vulnerable attachment, and impaired self-development are highlighted as possible pathways for psychopathology. Children with EA are vulnerable to mental health disorders, and this study may help clinicians to identify children at risk. [source]

The emergence of mucormycosis as an important opportunistic fungal infection: five cases presenting to a tertiary referral center for mycology

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2007
Mahreen Ameen MRCP
Background, Mucormycosis, a rare opportunistic fungal infection, is re-emerging in importance with the increase in prevalence of immunosuppressive states, both as a result of therapy and disease. Methods, We report five cases of mucormycosis diagnosed by the Dermatology Department and managed jointly with the Medical and Surgical Services of "Dr Manuel Gea Gonzalez" General Hospital in Mexico City, a tertiary referral center for mycology. We also review the current literature including recent advances in medical therapy. Results, Four of the five cases were of the rhino-orbital-cerebral variant, commonly associated with significant mortality, and one of these patients died despite early diagnosis and aggressive management. The fifth case was primary cutaneous mucormycosis and this patient survived infection without relapse. Diabetic ketoacidosis predisposed to infection in four cases and the other was associated with advanced human immunodeficiency virus infection. Radiologic imaging was important in cases of facial involvement in order to evaluate the extent of disease and possible intracranial involvement. All cases were managed with systemic antifungals and surgical debridement, together with the treatment of predisposing factors. Conclusions, These cases illustrate the need for early clinical recognition and prompt therapy, as well as the requirement for tissue biopsy in order to demonstrate the characteristic morphologic features of this fungal agent in the absence of positive mycology culture results. This report also highlights that, although rhino-orbital-cerebral mucormycosis requires effective multidisciplinary management, the disease not uncommonly presents to dermatologists for diagnosis. [source]

Review of assessment and treatment of PTSD among elderly American armed forces veterans

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2005
Gina P. Owens
Abstract Background The number of elderly combat veterans is steadily increasing in the US and estimates project that a notable percentage of these veterans experience symptoms of posttraumatic stress disorder (PTSD). Limited data exist specifically related to prevalence, assessment, and treatment of PTSD among the elderly veteran population. Objective This review summarizes the available research related to difficulties in assessment with the elderly American Armed Forces veteran population. In addition, both psychotherapeutic and pharmacological treatment interventions for PTSD are discussed. Methods A literature search was conducted using PsycINFO, Medline, and the National Center for PTSD's PILOTS database. Results Evidence suggests that elderly veterans generally present more somatic symptoms of PTSD. Medical and psychological comorbodities, such as depression, substance abuse, or cognitive deficits can further complicate the assessment process. Cut-scores for existing instruments need to be further established with elderly veterans. Use of exposure therapies with the elderly has not been adequately researched and mixed results have been obtained for supportive therapy for treatment of PTSD. Controlled research investigating pharmacological interventions for PTSD with the elderly is also limited. Conclusion Evidence suggests that some psychotherapeutic and pharmacological interventions already utilized with younger individuals may be useful with the elderly veteran population. However, research indicates that modifications may be required for working with the elderly population and further research in the areas of assessment and treatment are necessary. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Situational Tests in Student Selection: An Examination of Predictive Validity, Adverse Impact, and Construct Validity

INTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT, Issue 4 2002
Filip Lievens
The Flemish Admission Exam ,Medical and Dental Studies' is comprised of four cognitive ability tests and four situational tests, namely two work samples (i.e., a lecture and a medical text) and two video-based situational judgement tests (i.e., a physician,patient interaction and a medical expert discussion). On the basis of the Admission Exam scores of 941 candidates (359 men, 582 women) this study shows that situational tests significantly can predict better than cognitive ability tests, with lecture and text emerging as significant predictors. When situational tests are combined with cognitive ability tests, there are no mean gender differences. Situational tests also enable us to measure a broader range of constructs. For example, in this study, the personality factor Openness is related to better situational test performance. Overall, this study demonstrates that situational tests may be a useful complement to traditional student selection procedures. [source]

Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: Usefulness of adrenocortical scintigraphy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006
HIROFUMI IZAKI
Aim:, Laparoscopic adrenalectomy is currently indicated for biochemically and clinically functional adrenal tumors and potentially malignant tumors of the adrenal glands. Non-functional adenomas greater than 5 cm in diameter of the adrenal gland are generally considered to represent potentially malignant tumors. The present study shows indications of laparoscopic adrenalectomy for non-functional adrenal tumors with hypertension in a retrospective fashion. Methods:, Between 1994 and 2004, 110 laparoscopic adrenalectomies were performed at Tokushima University Hospital. All 110 patients underwent detailed endocrinological examination before surgery. Medical and operative records of these 110 patients (57 men, 53 women), including operative parameters, histopathological findings and pre- and postoperative hypertension, were reviewed. Forty-five patients underwent laparoscopic adrenalectomy for non-functional adrenal tumors, and [131I]6,-iodomethyl-19-norcholest-5(10)-en-3,-ol (NP-59) scintigraphy was performed for patients with preoperative hypertension. Results:, Mean patient age was 55.0 years (range, 22,77 years). Mean maximum tumor diameter was 42 mm (range, 20,105 mm). All adrenal tumors were removed successfully by laparoscopic surgery. Hypertension was postoperatively improved in seven of the 11 patients with preoperative hypertension, without subclinical Cushing syndrome. Importantly, all patients who improved hypertension after adrenalectomy displayed strong accumulation in adrenal tumors with visualization of the contralateral gland on NP-59 scintigraphy. Conversely, blood pressure did not improve in four patients for whom scintigraphy yielded negative results. Conclusions:, The indication of laparoscopic adrenalectomy for non-functional adrenal tumors is generally considered for lesions more than 5 cm diameter. However, the present study suggests that laparoscopic surgery should be considered even in patients with tumors less than 5 cm in diameter, if both hypertension and accumulation in tumors on NP-59 scintigraphy are present. [source]

Negative pressure wound therapy: treating a venomous insect bite

INTERNATIONAL WOUND JOURNAL, Issue 1 2007
Michael S Miller
Abstract Reports of spider bites appear throughout North America. Bites associated with the brown recluse spider (Loxosceles recluse) cause serious medical complications because the venom of this spider contains a powerful necrotising agent with the potential to cause severe cutaneous necrosis. Although not much is known regarding the application of negative pressure wound therapy (NPWT) to spider bites, this therapy has considerable literature support for its efficacy, cost-effectiveness and ease of use in chronic, difficult-to-heal wounds. A case study using NPWT to successfully treat a non healing upper arm wound presumed due to a venomous spider bite is presented here. The patient was successfully treated with a new, less costly NPWT product called the Versatile 1® and a new combination drain plus dressing called the Miller DermiVex® drain, both manufactured by Blue Sky Medical (Carlsbad, CA). [source]

Is Age Associated with the Number or Types of Medications Prescribed to Renal Transplant Recipients?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2007
Marie A. Chisholm PharmD
OBJECTIVES: To determine whether age influences the number or types of medications prescribed to younger (aged 18,64) and elderly (aged ,65) renal transplant recipients 3 years posttransplant. DESIGN: A cross-sectional study involving renal transplant recipients. SETTING: Medical College of Georgia. PARTICIPANTS: A random sample of 100 elderly and 100 younger renal transplant recipients who received posttransplant care at the Medical College of Georgia, were on stable immunosuppressant therapy regimens, and were at least 3 years posttransplant. MEASUREMENTS: Medical and pharmacy data of recipients were evaluated for demographics; presence of a lipid-lowering agent; number of antihypertensives, immunosuppressants, antidiabetic agents, and total medications; number of rejections; dose per kilogram of immunosuppressant(s); infection-related hospitalizations; and measures of blood pressure, blood glucose, serum creatinine, serum tacrolimus/cyclosporine concentrations, total cholesterol, and triglycerides. RESULTS: Elderly recipients were more likely to have diabetes mellitus before the transplant and to develop diabetes mellitus afterwards (P=.04) and were prescribed more total medications (12.40±3.72 vs 10.25±4.07, P<.001) and antidiabetic agents (0.89±0.93 vs 0.42±0.77, P<.001) 3 years posttransplant than younger recipients. Elderly recipients also had fewer chronic rejections, more infection-related hospitalizations, lower diastolic blood pressure, and greater fasting blood glucose levels 3 years posttransplant (P<.05) than younger recipients. CONCLUSION: Future investigation should focus on deciphering the implications of the greater numbers of medications prescribed to elderly renal transplant recipients in terms of maximizing desired health outcomes (e.g., graft survival) and minimizing adverse drug-related experiences (e.g., infection). [source]

A Nursing Home in Arab-Israeli Society: Targeting Utilization in a Changing Social and Economic Environment

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2005
Khalid Suleiman MD
This article is a case study of the first 10 years of operation (1992,2002) of the Dabouriya Home for the Aged, the first publicly funded culturally adapted nursing home for Israeli citizens of Arab descent. Although 44% of Arab Israelis and 26% of Jewish Israelis aged 65 and older are disabled, in 1999, 4.3% of the Jewish population but only 0.7% of the Arab-Israeli population aged 65 or older lived in long-term care institutions; disabled Arab-Israeli elderly were mainly cared for by families. As Arab-Israeli society modernizes and traditional caregiving is reduced, alternatives must be found for this growing, disabled population. Medical and administrative records of 404 people admitted consecutively to a 136-bed facility over 10 years were analyzed. Two distinct segments of the needy population were served: people with independent activity of daily living (ADL) function but little or no family to provide help with intermediate ADLs and those dependent in ADLs and with health problems, especially dementia. Economic, demographic, and social changes in Arab-Israeli society may mean that traditional caregivers will not be able to adequately care for this highly disabled population. Administrators of the public health system in Israel should be aware of the underutilization of publicly funded long-term care by disabled Arab Israelis and the lack of care alternatives for the population that does use nursing homes, because there may be severe consequences in terms of caregiver burden and social stress when disabled elderly people remain in unsuitable environments. [source]

Medical and Functional Consequences of Anemia in the Elderly

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3s 2003
David Lipschitz MD
Anemia is a common problem in the elderly, accounting for significant morbidity and mortality in this population. It also has a negative effect on quality of life. Recent findings have shown that anemia can lead to cardiovascular and neurological complications, such as congestive heart failure and impaired cognitive function. In addition, anemia has been implicated in functional impairment and falls. Available data have shown that the successful management of this condition will not only improve patients' quality of life, but may also prevent the anemia from worsening. [source]

Oxycellulose: Significant characteristics in relation to its pharmaceutical and medical applications

ADVANCES IN POLYMER TECHNOLOGY, Issue 3 2009
Bajerová Martina
Abstract As a biomaterial, cellulose can be converted into a wide range of derivatives with desired properties for a variety of medical, biomedical, and pharmaceutical applications. The oxidation of cellulose yields oxidized cellulose (OC, oxycellulose, 6-carboxycellulose). OC represents an important class of biocompatible and bioresorbable polymers. In vivo bioabsorption of OC occurs via chemical depolymerization and enzymatic hydrolysis. Despite the fact OC is well established as a hemostatic agent and is widely used in a clinical practice, it still attracts a great interest and its new applications, especially pharmaceutical, are investigated. The present review is focused on characterization of OC's physical and chemical properties. Its synthesis and mechanisms involved in its in vivo and in vitro biodegradation are discussed. Medical and biomedical applications of OC are summarized, and especially its hemostatic, enterosorbent, and wound-healing properties are described. In addition to these applications, OC could be used as a pharmaceutical excipient in solid (e.g., tablets, microparticles), semisolid (e.g., gels), as well as liquid (e.g., suspensions) dosage forms. © 2009 Wiley Periodicals, Inc. Adv Polym Techn 28:199,208, 2009; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/adv.20161 [source]

Chlorhexidine release and antibacterial properties of chlorhexidine-incorporated polymethyl methacrylate-based resin cement

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2010
N. Hiraishi
Abstract This study evaluated chlorhexidine release from experimental, chlorhexidine-incorporated polymethyl methacrylate (PMMA)-based resin cements prepared from Super-Bond C&B (Sun Medical) and examined the antimicrobial activity against Streptococcus mutans and Enterococcus faecalis. Chlorhexidine diacetate was added into PMMA polymer to obtain chlorhexidine concentration of 0.0, 1.0, 2.0, 3.0, and 4.0 wt %. Chlorhexidine-incorporated, cured resin disks were immersed in distilled water at 37°C for 5 weeks, and the chlorhexidine release was analyzed by high-performance liquid chromatography. The antibacterial effect of freshly mixed resin cements was examined using the agar diffusion test. For the direct contact test, the wells (n = 6) of microtiter plates were coated with cements. The coated wells were aged up to 3 weeks prior to the placement of bacterial suspensions directly on cured cements. The 3.0 and 4.0% chlorhexidine-incorporated cement exhibited chlorhexidine release for 5 weeks; however, more than 98% of chlorhexidine was retained in resin matrix. No release was detected from the 1.0 and 2.0% incorporated cement at 1 week and 2 weeks, respectively. The agar diffusion test failed to detect antibacterial effects against Enterococcus faecalis, whereas the direct contact test revealed the antibacterial effect of 3.0 and 4.0% incorporated cements against each microbe for 2 weeks. The 3.0 and 4.0% chlorhexidine-incorporated resin cement possessed prolonged chlorhexidine release and antibacterial properties for 2 weeks. © 2010 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2010 [source]

Effect of curing mode on bond strength of self-adhesive resin luting cements to dentin

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2010
T. R. Aguiar
Abstract In this study, the in vitro bond strength of dual-curing resin cements to indirect composite restorations when the cement was either light polymerized or allowed to only autopolymerize was evaluated. Occlusal dentin surfaces of 56 extracted human third molars were flattened to expose coronal dentin. Teeth were assigned to eight groups (n = 7) according to resin cement products and polymerization modes: conventional cement (Panavia F 2.0; Kuraray Medical) and self-adhesive cements [RelyX Unicem (3M ESPE), BisCem (Bisco), and G-Cem (GC Corp.)]. Cements were applied to prepolymerized resin discs (2-mm-thick Sinfony; 3M ESPE), which were subsequently bonded to the prepared dentin surfaces. The restored teeth were either light-polymerized through the overlying composite according to manufacturers' instructions or were allowed to only self-cure. After 24 h, the teeth and restorations were sectioned to obtain multiple bonded beams (1.0 mm2) and tested in tension at a crosshead speed of 0.5 mm/min until failure. Data (MPa) were analyzed by two-way ANOVA and Tukey test (, = 0.05). Light activation of some cement systems (G-Cem and Panavia F 2.0) increased the bond strength, while the curing mode did not affect the bond strength for some (RelyX Unicem and BisCem). The bond strength in the autopolymerized mode varied among products. In general, the use of self-adhesive resin cements did not provide significantly higher bond strengths than that of a conventional material, and two self-adhesive cements yielded significantly lower bond values (regardless of cure mode) than the other products. © 2010 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2010 [source]

Bone microstructure at the distal tibia provides a strength advantage to males in late puberty: An HR-pQCT study

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2010
Melonie Burrows
Abstract Bone is a complex structure with many levels of organization. Advanced imaging tools such as high-resolution (HR) peripheral quantitative computed tomography (pQCT) provide the opportunity to investigate how components of bone microstructure differ between the sexes and across developmental periods. The aim of this study was to quantify the age- and sex-related differences in bone microstructure and bone strength in adolescent males and females. We used HR-pQCT (XtremeCT, Scanco Medical, Geneva, Switzerland) to assess total bone area (ToA), total bone density (ToD), trabecular bone density (TrD), cortical bone density (CoD), cortical thickness (Cort.Th), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular spacing standard deviation (Tb.Sp SD), and bone strength index (BSI, mg2/mm4) at the distal tibia in 133 females and 146 males (15 to 20 years of age). We used a general linear model to determine differences by age- and sex-group and age,×,sex interactions (p,<,0.05). Across age categories, ToD, CoD, Cort.Th, and BSI were significantly lower at 15 and 16 years compared with 17 to 18 and 19 to 20 years in males and females. There were no differences in ToA, TrD, and BV/TV across age for either sex. Between sexes, males had significantly greater ToA, TrD, Cort.Th, BV/TV, Tb.N, and BSI compared with females; CoD and Tb.Sp SD were significantly greater for females in every age category. Males' larger and denser bones confer a bone-strength advantage from a young age compared with females. These structural differences could represent bones that are less able to withstand loads in compression in females. © 2010 American Society for Bone and Mineral Research [source]

Severity of Vertebral Fractures Is Associated With Alterations of Cortical Architecture in Postmenopausal Women,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2009
Elisabeth Sornay-Rendu
Abstract Patients with vertebral fractures (VFx) have trabecular architectural disruption on iliac biopsies. Because cortical bone is an important determinant of bone strength, we assessed cortical and trabecular microarchitecture at peripheral sites in patients with VFx of varying number (N) and severity (S). Bone architecture and volumetric density (vBMD) were assessed at the distal radius and tibia with HR-pQCT (XTreme CT; Scanco Medical, Bassersdorf, Switzerland) in 100 women with VFx (age, 74 ± 9 yr) of different S (GI, n = 23; GII, n = 35; GIII, n = 42) and in 362 women (age, 69 ± 7 yr) without peripheral or VFx (G0) from the OFELY study. Spine areal BMD (aBMD) was assessed by DXA. Among all women, at the radius and after adjustment for age and aBMD, there were significant trends in lower vBMD, cortical thickness (Cort.Th), trabecular number (Tb.N) and thickness (Tb.Th), higher trabecular separation (Tb.Sp), and distribution of separation (Tb.Sp.SD) with greater VFx S and N. Among women with VFx, lower Cort.Th and cortical vBMD (D.Cort) were associated with severe (GIII) and multiple (n > 2) VFx (p < 0.05). The age-adjusted OR for each SD decrease of Cort.Th was 2.04 (95% CI, 1.02,4.00) after adjustment for aBMD. At the tibia, there were trends for lower vBMD, Tb.N, Tb.Th, and higher Tb.Sp and Tb.Sp.SD with greater VFx S and N (p < 0.001). Among women with VFx, lower Cort.Th and D.Cort were associated with severe and multiple (n > 3) VFx (p < 0.01). In postmenopausal women, VFx are associated with low vBMD and architectural decay of trabecular and cortical bone at the radius and tibia, independently of spine aBMD. Severe and multiple VFx are associated with even more alterations of cortical bone. [source]