JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2005
Helen Best BDS MDS PhD
Abstract Aim/Objective, The purpose of the study was to undertake analyses of treatment data for the Personal Dental Services (PDS) of Lambeth, Southwark and Lewisham Primary Care Trusts and relate the analyses to the PDS goals of supporting practitioners deliver appropriate quality dental care and ensuring that appropriate quality safety net services are available for all residents. Method, Analyses of treatment data provided by the Dental Practice Board were undertaken for the post-PDS period (February 1999,March 2003, based on data availability). Analyses of the clinic notes for 1500 patients were also undertaken for the 1 year pre-PDS period (October 1997,September 1998) and post-introduction of the PDS (October 1998,June 2003). Two sets of analyses were undertaken to evaluate trends in treatment claims for the Dental Practice Board data, absolute numbers of each type of treatment claimed each month and change in numbers of types of treatments claimed over time. The clinic notes were used to undertake post-PDS, pre-PDS comparisons of the number of treatment items and grouped treatment item categories undertaken and the number of courses and percentages of private treatment items provided. The following sociodemographic characteristics of the patients were also analysed, age, gender, exemption ,status ,and ,attendance ,status. Results, Overall it was identified that the percentage reduction in the number of treatment items undertaken was 13% (95% CI ,19%, ,7%), post- as compared to the pre-PDS introduction period. On an annual basis it was identified that the percentage reduction in the number of treatment items undertaken per year per patient post-PDS was 4% (95% CI ,6%, ,2%). There were significant variations in the impact of the PDS on the number of treatment items undertaken for different types of patients. A limited number of treatment types changed significantly post- as compared to pre-PDS. The proportion of exempt patients treated did not increase ,post-PDS. Conclusions, It is possible that a less, invasive style of dental treatment was provided during the course of the PDS, however, there was only limited evidence to indicate that dentists practice style changed based on types of treatment categories provided. The PDS provided a limited safety net service for local residents. In setting program goals the nature of quality dental practice requires definition and evaluation should be undertaken on a prospective basis. [source]

Evaluation of the Personal Dental Services (Wave 1) for Lambeth, Southwark and Lewisham Primary Care Trusts , Part 1: Retrospective analyses of registration data and access issues

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2005
Helen Best BDS MDS PhD
Abstract Aim/objective, The purpose of the study was to undertake analyses of registration data for the personal dental services (PDS) of Lambeth, Southwark and Lewisham primary care trusts and relate the analyses to the PDS goal ,of ,increasing ,uptake ,of ,dental services. Method, Secondary analyses of registration statistics provided by the Dental Practice Board were undertaken for both 1 years pre-PDS (October 1997 to September 1998) and post-PDS (October 1998 to March 2003) periods. Three sets of analyses were undertaken to consider different aspects of changing registrations: (1) Absolute numbers of patients registered at each time interval; (2) Rates of change in numbers of patients registered for the entire period after the introduction of PDS; and (3) Rates of change in numbers of patients registered ,for ,the ,most recent 3 years of available data. Results, There was a significant increase in the numbers of children registered under capitation, post-PDS as compared to the pre-PDS level (all ages and both genders combined). Post-PDS, the rate of increase for the children was approximately one additional child per practice per month (0.96, 95% CI 0.41,1.52). Similarly there was a significant trend for increasing adults registrations over time of about two and a half adults per practice per month (2.42, 95% CI 0.90,3.95). There was no evidence of a change in registrations for children or adults in total over the most recent period of 3 years. Conclusions, The analysis of the absolute numbers of registered patients each month indicated that the PDS practices had more children registered than before the implementation of the PDS scheme, but not adults. Overall post-implementation there was a trend for increasing registrations in both children and adults, but the most recent data indicated a plateau effect. Further consideration of facilitators to achieve PDS goals of improved uptake of services is required, particularly as they relate to local contexts. [source]

Measurement of Antiplatelet Inhibition during Neurointerventional Procedures: The Effect of Antithrombotic Duration and Loading Dose

JOURNAL OF NEUROIMAGING, Issue 1 2010
DJ Pandya MD
ABSTRACT BACKGROUND/OBJECTIVE Symptomatic thromboembolic events are the most common complications associated with aneurysm coiling, and carotid and intracranial stenting. Our objective is to assess the effect of aspirin (ASA) and clopidogrel dose and duration on platelet inhibition using a point of care assay in neurointerventional (NI) suite. METHOD The dose, duration, and point of care platelet function assay data for clopidogrel and aspirin therapy were prospectively collected between February 2006 and November 2007. Inadequate platelet inhibition for ASA was defined as ,550 ASA reaction units (ARU), and for clopidogrel was defined as ,50% inhibition of the P2Y12/ADP receptor RESULTS We collected data from 216 consecutive patients. Inadequate platelet inhibition was noted in 13% of patients on aspirin and 66% of patients on clopidogrel (P -value < .0001). Patients taking clopidogrel 75 mg for ,7 days, 300 mg for 24 hours, and 600 mg same day load had a mean P2Y12/ADP inhibition of 45%, 35% (P- value = .09), and 16%, respectively (P -value = .005). CONCLUSION Premedication with clopidogrel, in contrast to aspirin, does not achieve adequate platelet inhibition in about two-third of the patients. Same day antiplatelet loading may be insufficient to achieve adequate platelet inhibition and should be avoided if clinically feasible. J Neuroimaging 2010;20:64-69. [source]

The Organic Brain Syndrome (OBS) scale: a systematic review

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2006
Karin Björkman Björkelund
Abstract Background/Objective The Organic Brain Syndrome (OBS) Scale was developed to determine elderly patients' disturbances of awareness and orientation as to time, place and own identity, and assessment of various emotional and behavioural symptoms appearing in delirium, dementia and other organic mental diseases. The aim of the study was to examine the OBS Scale, using the eight criteria and guidelines formulated by the Scientific Advisory Committee of the Medical Outcomes Trust (SAC), and to investigate its relevance and suitability for use in various clinical settings. Method Systematic search and analysis of papers (30) on the OBS Scale were carried out using the criteria suggested by the SAC. Results The OBS Scale in many aspects satisfies the requirements suggested by the SAC: conceptual and measurement model, reliability, validity, responsiveness, interpretability, respondent and administrative burden, alternative forms of administration, and cultural and language adaptations, but there is a need for additional evaluation, especially with regard to different forms of reliability, and the translation and adaptation to other languages. Conclusions The OBS Scale is a sensitive scale which is clinically useful for the description and long-term follow-up of patients showing symptoms of acute confusional state and dementia. Although the OBS Scale has been used in several clinical studies there is need for further evaluation. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstruction

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010
H. WULF
Background/Objective: Our aim was to evaluate analgesia, motor block and pharmacokinetics of ropivacaine 0.2% and 0.75% in a femoral nerve block (FNB) in day case patients for anterior crucial ligament (ACL)-reconstruction compared with bupivacaine 0.25% and placebo. Methods: Following ethics committee approval and informed consent, 280 patients were randomly allocated to four groups for single-shot FNB [30 ml ropivacaine 0.2% (group RO2.0), 0.75% (RO7.5), bupivacaine 0.25% (BU2.5) and NaCl 0.9% (NaCl)]. Analgesia (pain scores, primary outcome) and motor block were assessed at 4 h (dismissal) and up to 24 h. Plasma concentration was determined up to 240 min thereafter. Results: Pain scores at 4 h were significantly higher for NaCl 4 (0,8) (median, range) (vs.) BU2.5 2 (0,8), RO2.0 3 (0,9) and RO7.5 2 (0,8) (NS within the LA groups). Patients of the NaCl group needed analgesics significantly more often (93%) within 4 h after surgery vs. 16% of group RO2.0, 19% of group RO7.5 and 19% of group BU2.5. Motor block was significantly increased with all local anesthetics without a significant difference within the LA groups 3 (0,5) in RO2.0, 3 (0,5) in RO7.5 and 3 (0,4) in BU2.5 vs. 0 (0,3) in group NaCl (median (range); scale from 0=full strength to 5=complete paralysis). Peak plasma concentrations differed significantly: RO7.5: 1.4 ± 0.4 (0.73,2.6) [,g/ml, mean ± SD (range)] after 33 ± 14 (10,40) min, RO2.0: 0.6 ± 0.3 (0.13,1.0) after 22+17 (10,60) and BU2.5: 0.3 ± 0.16 (0.05,0.62) at 31 ± 17 (10,60), respectively. Conclusion: FNB for ACL reconstruction with ropivacaine or bupivacaine provided better post-operative analgesia than placebo without reaching toxic plasma concentrations. Significant motor block was observed after 4 h in all groups including the lowest concentration of ropivacaine but occurred even with placebo. [source]

ORIGINAL ARTICLE: Investigation of the prediction accuracy of vancomycin concentrations determined by patient-specific parameters as estimated by Bayesian analysis

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 5 2010
Y. Hiraki BSc
Summary Background/Objective:, There have been many studies of therapeutic drug monitoring (TDM) of vancomycin (VCM) based on Bayesian analysis, but there have been no reports of the accuracy of prediction based on Bayesian-estimated patient-specific parameters. This study was conducted to compare the accuracy of prediction based on the population pharmacokinetic (PPK) method and Bayesian-estimated parameters. Method:, The subjects were 22 patients who were treated with VCM for MRSA infection and whose blood was sampled twice or more during the administration period. The concentrations between the blood samples were predicted based on the concentrations in the first blood samples based on the PPK method using mean parameters for the Japanese population and Bayesian-estimated patient-specific pharmacokinetic parameters. The mean prediction error (ME), mean absolute error (MAE) and root mean squared error (RMSE) were compared to examine the accuracy of prediction based on Bayesian-estimated patient-specific parameters. Results and discussion:, The mean measured VCM concentration was 10·43 ± 5·19 ,g/mL, whereas the mean concentration predicted based on the PPK method was 8·52 ± 4·34 ,g/mL, with an ME of ,1·91, MAE of 2·93 and RMSE of 3·21. The mean concentration predicted based on patient-specific parameters was 9·62 ± 4·95 ,g/mL with ME of ,0·81, MAE of 1·38 and RMSE of 1·74. The ME and MAE for the concentrations predicted using patient-specific parameters were smaller compared with those predicted using the PPK method (P = 0·0471 and 0·0003, respectively), indicating superior prediction with a significant difference between approaches. Conclusion:, Prediction using Bayesian estimates of patient-specific parameters was better than by the PPK method. However, when using patient-specific parameters it is still necessary to fully understand the clinical status of the patient and frequently determine VCM concentrations. [source]

Carbon monoxide produced by intrasinusoidally located haem-oxygenase-1 regulates the vascular tone in cirrhotic rat liver

LIVER INTERNATIONAL, Issue 5 2009
Lien Van Landeghem
Abstract Background/Objective: Carbon monoxide (CO) produced by haem-oxygenase isoforms (HO-1 & HO-2) is involved in the regulation of systemic vascular tone. We aimed to elucidate the vasoregulatory role of CO in the microcirculation in normal and thioacetamide cirrhotic rat livers. Methods: Haem-oxygenase expression was examined by Western blot. Total HO enzymatic activity was measured spectrophotometrically. Sensitivity of hepatic stellate cells (HSCs) to CO-mediated relaxation was studied by a stress-relaxed-collagen-lattice model. To define the relative role of CO, the CO-releasing molecule CORM-2, the HO-inhibitor zinc protoporphyrin-IX and the HO-1 inducer hemin were added to an in situ liver perfusion set-up. The topography of vasoactive CO production was evaluated by applying different CO- and nitric oxide-trapping reagents in the liver perfusion set-up and by immunohistochemistry. Results: Western blot showed decreased expression of both HO isoenzymes (P<0.036 for HO-1; P<0.001 for HO-2) in cirrhotic vs normal rat livers, confirmed by the HO-activity assay (P=0.004). HSCs relaxed on exposure to CORM-2 (P=0.013). The increased intrahepatic vascular resistance (IHVR) of cirrhotic rats was attenuated by perfusion with CORM-2 (P=0.016) and pretreatment with hemin (P<0.001). Inhibition of HO caused a dose-related increase in IHVR in normal and cirrhotic liver. In normal liver, the haemodynamically relevant CO production occurred extrasinusoidally, while intrasinusoidally HO-1 predominantly regulated the microcirculation in cirrhotic livers. Conclusion: We demonstrate a role for CO and HO in the regulation of normal and cirrhotic microcirculation. These findings are of importance in the pathophysiology of portal hypertension and establish CO/HO as novel treatment targets. [source]

Hyperglycemia not hypoglycemia alters neuronal dendrites and impairs spatial memory

PEDIATRIC DIABETES, Issue 6 2008
John I Malone
Background/Objective:, We previously reported that chronic hyperglycemia, but not hypoglycemia, was associated with the reduction of neuronal size in the rat brain. We hypothesized that hyperglycemia-induced changes in neuronal structure would have negative consequences, such as impaired learning and memory. We therefore assessed the effects of hyperglycemia and hypoglycemia on neuronal dendritic structure and cognitive functioning in young rats. Design/Methods:, Experimental manipulations were conducted on male Wistar rats for 8 wk, beginning at 4 wk of age. At the completion of the treatments, all rats were trained in the radial-arm water maze, a spatial (hippocampus-dependent) learning and memory task. Three groups of rats were tested: an untreated control group, a streptozotocin-induced diabetic (STZ-D) group, and an intermittent hypoglycemic group. Following behavioral training, the brains of all animals were examined with histologic and biochemical measurements. Results:, Peripheral hyperglycemia was associated with significant increases in brain sorbitol (7.5 ± 1.6 vs. 5.84 ± 1.0 ,M/mg) and inositol (9.6 ± 1.4 vs. 7.1 ± 1.1 ,M/mg) and reduced taurine (0.65 ± 0.1 vs. 1.3 ± 0.1 mg/mg). Histologic evaluation revealed neurons with reduced dendritic branching and spine density in STZ-D rats but not in control or hypoglycemic animals. In addition, the STZ-D group exhibited impaired performance on the water maze memory test. Conclusions:, Hyperglycemia, but not hypoglycemia, was associated with adverse effects on the brain polyol pathway activity, neuronal structural changes, and impaired long-term spatial memory. This finding suggests that the hyperglycemic component of diabetes mellitus has a greater adverse effect on brain functioning than does intermittent hypoglycemia. [source]

An in-home geriatric programme for vulnerable community-dwelling older people improves the detection of dementia in primary care

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2008
M. Perry
Abstract Background/objective Dementia is under-diagnosed in primary care. This study investigated whether an in-home geriatric assessment and management programme could improve the identification of patients with dementia in primary care. Methods A secondary analysis was performed, using data of a randomised controlled trial that studied the effects of an in-home geriatric evaluation and management programme compared with usual care. In this trial, 151 vulnerable community-dwelling patients, aged 70 years and older, participated: 86 in the intervention group and 66 in de control group. The effect of the programme on the dementia detection rate was determined by comparing the number of new dementia diagnoses in both study arms at 6 months follow-up. Results Of all 151 participants, 38 (25%) had a registered dementia diagnosis at baseline. During follow-up, 23 of 113 patients without a registered dementia diagnosis at baseline were identified as suffering from dementia. The difference between the numbers of new dementia diagnoses in the intervention group (19 of 66 patients) and the control group (4 of 47 patients) was significant. (p,=,0.02) Conclusion An in-home geriatric assessment and management programme for vulnerable older patients improves the detection of dementia and can therefore contribute to overcoming of under-diagnosis of dementia. Copyright © 2008 John Wiley & Sons, Ltd. [source]

ACUTE APOPTOTIC RESPONSE INDUCED BY THE COLON CARCINOGEN AOM IS DEPENDENT ON P53 GENE and NOT THE APC GENE

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2001

Background/objective, Apoptosis is disordered in tumourigensis, however, the importance of apoptosis in relation to DNA damage created at the time of initiation by genotoxic carcinogens, i.e. the acute apoptotic response to genotoxic carcinogens (AARGC), has hardly been explored. p53 and APC are tumor suppressor genes known to be altered frequently in colon cancer, however, it remains unclear whether AARGC is dependent on the function of p53 or APC. p53 ,/,, p53 ± and APCMin/+ mice provide an excellent model to test the biological significance of AARGC in colon in terms of its ability to delete genetically damaged cells that might progress to cancer. Thus, we have tested the hypothesis that p53 and APC play a critical role in AARGC, by studying AARGC in p53+/, , p53 ,/, mice and APCMin/+0. Methods, p53 knockout mice were produced by breeding male p53+/, with female C57BL/J mice or interbreeding p53+/, mice. APCMin/+ mice were produced by breeding male APCMin/+ mice with female C57BL/J mice. Mice geno-typing were confirmed by PCR. At 10,12 weeks age, 44 mice were given a single subcutaneous azoxymethane (AOM 10 mg/kg) injection to induce AARGC, and killed 6 h later (the time of the maximal response). There were eight p53,/, mice, 11 p53+/, mice, nine p53+/+mice, 12 APCMin/+ mice, and six APC+/+ mice. Three p53,/, mice, four p53+/, mice, seven p53+/+ mice, two APCMin/+, and six APC+/+ mice without AOM injection were used as controls. Apoptosis in colon was measured by classic morphological H & E criteria. Results, In p53+/+ mice, AOM induced a significant increase in apoptosis (4.70 ± 0.35, SEM, apoptotic cells per crypt column) in the distal colon, located almost exclusively in the proliferative compartment. In comparison to the pattern of apoptosis observed in the p53+/+ mice, the apoptotic response of p53,/, mice was almost nonexistent (0.12 ± 0.06) while in p53+/, mice it was significantly suppressed by approximately 50% (2.26 ± 0.28); P < 0.01. In contrast to the importance of p53 gene on AARGC, absence of the APC gene had no obvious effect on AARGC: APCMin/+ mice (5.07 ± 0.30) and APC+/+ (5.50 ± 0.33); P > 0.05. Conclusion, p53 function appears to be critically important for carcinogen-induced apoptosis in colon, while APC homeostasis appears not to be involved in this type of apoptosis. The loss of just one allele of p53, interferes with its function. Further studies are required to determine whether defective AARGC in p53 knockout mice puts them at increased risk of subsequent events in tumorigensis, and whether AARGC can be regulated by known protective agents. [source]

Inhibition and reversal of platelet-rich arterial thrombus in vivo: direct vs. indirect factor Xa inhibition

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 12 2004
K. KARNICKI
Summary.,Background/objective: The efficacy of a direct factor (F)Xa inhibitor, ZK-807834, was compared with indirect inhibition by enoxaparin for inhibition and deaggregation of acute platelet-rich thrombi in a well-characterized porcine carotid injury model. Methods: A crush injury was performed on a randomly chosen carotid artery and the thrombus allowed to propagate for 30 min. Pigs then received intravenous drug for 35 min: ZK-807834-Dose 1 (40 µg kg,1 bolus +,1.5 µg kg,1 min,1 infusion, n = 6); ZK-807834-Dose 2 (20 µg kg,1 bolus +,0.75 µg kg,1 min,1 infusion; n = 6); enoxaparin (1 mg kg,1 bolus; n = 6); or saline (n = 6). Five minutes after drug initiation, the contralateral artery was injured. Thrombus size was monitored by scintillation detection of autologous 111In-platelets. Results: The prothrombin time ratio was 2.2 ± 0.1; 1.4 ± 0.3; 1.2 ± 0.9 and 1.1 ± 0.2, respectively. ZK-807834-Dose 1 significantly inhibited carotid platelet deposition (525 ± 226 × 106 cm,2; P = 0.008), whereas ZK-807834-Dose 2 (2325 ± 768) and enoxaparin (1236 ± 383) were not different from saline (2776 ± 642). Thrombus deaggregation was greatest for animals receiving ZK-807834-Dose 1 (473 ± 185). Neither ZK-807834-Dose 2 (1588 ± 480) nor enoxaparin (1618 ± 686) was different from saline control (2222 ± 598). Conclusions: Direct FXa inhibition with ZK-807834, at a prothrombin time ratio of 2.2, effectively inhibits thrombosis and promptly deaggregates thrombi induced by arterial injury. In contrast, indirect FXa inhibition with enoxaparin was ineffective. [source]

Cross-Sectional Imaging Characteristics of Pituitary Adenomas, Invasive Adenomas and Adenocarcinomas in Dogs: 33 Cases (1988,2006)

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010
Rachel E. Pollard
Background: Pituitary tumors in dogs can be adenomas, invasive adenomas, or adenocarcinomas. In people, invasive adenomas and pituitary adenocarcinomas carry a worse prognosis than adenomas. Hypothesis/Objective: To identify differentiating features on cross-sectional imaging in dogs with pituitary adenomas, invasive adenomas, and adenocarcinomas. Animals: Thirty-three dogs that had computed tomography (CT) or magnetic resonance imaging (MRI) performed and a necropsy diagnosis of pituitary adenoma (n= 20), invasive adenoma (n= 11), or adenocarcinoma (n= 2). Methods: Medical records were retrospectively reviewed for signalment, history, and diagnosis. CT and MR images were reviewed for characteristics of pituitary tumors. Results: Mean (± standard deviation) age for dogs with pituitary adenomas (10.6 ± 2.9 years) was greater than that of those with invasive adenomas (8.3 ± 2.7 years, P= .04). Eighteen out of 20 (90%) dogs with adenomas had contrast-enhancing masses. Thirteen out of 20 (65%) had homogeneous enhancement. Mean adenoma height was 1.2 ± 0.7 cm. Eight out of 20 (40%) adenomas were round and 8/20 (40%) compressed surrounding brain. Eleven out of 11 dogs (100%) with invasive adenomas had contrast-enhancing masses. Seven out of 11 (64%) masses were homogeneous. Mean invasive adenoma height was 1.8 ± 0.7 cm, which was significantly greater than adenomas (P= .03). Mass shape varied from round to oval to irregular. Six out of 11 (55%) masses compressed surrounding brain. Clinical and imaging features were variable for 2 dogs with adenocarcinomas. Conclusions and Clinical Relevance: Invasive adenoma should be suspected if a dog with a pituitary tumor is <7.7 years of age and has a mass >1.9 cm in vertical height. Adenocarcinomas are uncommon and metastatic lesions were not seen with imaging. [source]

Effects of Body Positioning on Swallowing and Esophageal Transit in Healthy Dogs

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2009
C.M. Bonadio
Background: Contrast videofluoroscopy is the imaging technique of choice for evaluating dysphagic dogs. In people, body position alters the outcome of videofluoroscopic assessment of swallowing. Hypothesis/Objective: That esophageal transit in dogs, as measured by a barium esophagram, is not affected by body position. Animals: Healthy dogs (n= 15). Methods: Interventional, experimental study. A restraint device was built to facilitate imaging of dogs in sternal recumbancy. Each dog underwent videofluoroscopy during swallowing of liquid barium and barium-soaked kibble in sternal and lateral recumbancy. Timing of swallowing, pharyngeal constriction ratio, esophageal transit time, and number of esophageal peristaltic waves were compared among body positions. Results: Transit time in the cervical esophagus (cm/s) was significantly delayed when dogs were in lateral recumbency for both liquid (2.58 ± 1.98 versus 7.23 ± 3.11; P= .001) and kibble (4.44 ± 2.02 versus 8.92 ± 4.80; P= .002). In lateral recumbency, 52 ± 22% of liquid and 73 ± 23% of kibble swallows stimulated primary esophageal peristalsis. In sternal recumbency, 77 ± 24% of liquid (P= .01 versus lateral) and 89 ± 16% of kibble (P= .01 versus lateral) swallows stimulated primary esophageal peristalsis. Other variables were not significantly different. Conclusions and Clinical Importance: Lateral body positioning significantly increases cervical esophageal transit time and affects the type of peristaltic wave generated by a swallow. [source]

Glucocorticoids Inhibit Diastrophic Dysplasia Sulfate Transporter Activity in Otosclerosis by Interleukin-6

THE LARYNGOSCOPE, Issue 9 2006
Yutaka Imauchi MD
Abstract Hypothesis/Objective: Otosclerosis is a bone remodeling disorder localized to the otic capsule and associated with inflammation. In vitro, increased activity of the diastrophic dysplasia sulf/te transporter (DTDST), which is implicated in bone metabolism, has been reported. Because glucocorticoids modulate the bone turnover and inhibit inflammatory processes, we investigated the effect of dexamethasone (Dex) on interleukin-6 and DTDST in otosclerosis. Study Design: The authors conducted a prospective, case,control study. Materials and Methods: Primary cell cultures were obtained from stapes and external auditory canals in otosclerosis (n = 21) and control patients (n = 18). Assays with [3H]Dex evaluated specific binding sites in otosclerotic and control stapes. The effects of Dex (10,9 to 10,6 M) and RU486 (10,7 M), a glucocorticoid antagonist, were studied on DTDST activity by sulfate uptake. IL-6 secretion was measured in culture media before and after Dex (10,7 M, 24 hours). The effect of IL-6 (10,7 M, 24 hours) was assessed on DTDST activity in control stapes. Results: The number of specific Dex-binding sites was similar in all stapedial cultures. Dex inhibited DTDST activity (19.4 ± 1.02 vs. 29.4 ± 3.94 pmol/,g prot/5 minutes) only in otosclerotic stapes. This effect was dose-dependent, antagonized by RU 486 and only observed 24 hours after Dex exposure. Interleukin (IL)-6 stimulated DTDST activity in normal stapes, whereas Dex inhibited IL-6 production only in otosclerotic stapes. Conclusion: Dex inhibits the DTDST activity, at least in part, through a reduction of IL-6 secretion only in otosclerotic cells. This effect is mediated through the glucocorticoid receptors and may lead to the reduction of bone turnover. [source]

Limited Use of Complementary and Alternative Medicine in Israeli Head and Neck Cancer Patients

THE LARYNGOSCOPE, Issue 8 2005
FACS, Yoav P. Talmi MD
Abstract Hypothesis/Objective: The use of complementary or alternative medicine (CAM) is growing among cancer patients. A Medline search failed to reveal any dedicated report of CAM use specifically in patients with head and neck cancer (HNC). Study Design: Use of CAM was evaluated in a cohort of treated HNC patients. Methods: Patients treated for HNC were asked if they had used CAM since their diagnosis. Demographic data and data pertaining to mode of CAM, duration of treatment and effects were obtained. Results: One hundred forty-three patients (mean age 61 years) were included. Only nine patients (6.3%) reported using disease related CAM. This included acupuncture (4), Reiki (2), naturopathy (2), hypnosis (1), shiatsu (1), chiropractic treatment (1), homeopathy (1), and selenium (1). Conclusion: Contrary to the reported use, few of our HNC patients used CAM. Although this could be related to good caregiver-patient relationship, further studies in comparable populations are warranted to evaluate if this is a local or a pervading finding in head and neck cancer patients. [source]

Digital Block With and Without Epinephrine During Chemical Matricectomy with Phenol

DERMATOLOGIC SURGERY, Issue 10 2010
H. CEVDET ALTINYAZAR MD
BACKGROUND Digital block with epinephrine is safe in selected patients. Chemical matricectomy with phenol is a successful, cheap, and easy method for the treatment of ingrown nails. OBJECTIVE To determine the effect of digital block with epinephrine in chemical matricectomy with phenol. MATERIAL AND METHODS Forty-four patients with ingrown toenail were randomly divided into two groups. The plain lidocaine group (n=22) underwent digital anesthesia using 2% plain lidocaine, and the lidocaine with epinephrine group (n=22) underwent digital anesthesia with 2% lidocaine with 1:100,000 epinephrine. In the postoperative period, the patients were evaluated for pain, drainage, and peripheral tissue destruction and were followed for up to 18 months for recurrence. RESULTS The mean anesthetic volume used in the epinephrine group (2.2±0.4 mL) was significantly lower than the plain lidocaine group (3.1±0.6 mL). There was no statistically significant difference in postoperative pain and recurrence rates, but duration of drainage was significantly shorter in the epinephrine group (11.1±2.5 days) than in the plain lidocaine group (19.0±3.8 days). CONCLUSION Digital block with epinephrine is safe in selected patients, and epinephrine helps to shorten the postoperative drainage period. The authors have indicated no significant interest with commercial supporters. [source]

Enhancing the Growth of Natural Eyelashes: The Mechanism of Bimatoprost-Induced Eyelash Growth

DERMATOLOGIC SURGERY, Issue 9 2010
2Article first published online: 2 APR 2010, JOEL L. COHEN MD
BACKGROUND Many women desire prominent eyelashes. In December 2008, bimatoprost ophthalmic solution 0.03% was approved for the treatment of hypotrichosis of the eyelashes in the United States. OBJECTIVE To review eyelash physiology and the proposed mechanisms by which the topical pros-tamide product bimatoprost enhances eyelash growth. METHODS AND MATERIALS Clinical and preclinical studies pertaining to the efficacy, safety, and mechanisms of action of bimatoprost are presented. RESULTS Treatment with bimatoprost increases the percentage of eyelash follicles in anagen at any one time. This probably accounts for its ability to lengthen lashes. Bimatoprost-induced stimulation of melanogenesis appears to result in darker lashes and, at the same time, appears to increase the size of the dermal papilla and hair bulb, affecting lash thickness and fullness. Such effects, largely demonstrated in animal studies, are consistent with the results of a recent Food and Drug Administration phase III clinical trial. The favorable safety profile of bimatoprost in human subjects is probably secondary to the limited exposure of ocular tissues resulting from topical application at the base of the upper lashes. CONCLUSION By influencing the eyelash hair cycle and follicles, bimatoprost ophthalmic solution 0.03% is a safe and effective means of enhancing eyelash growth. Dr. Cohen has served as a consultant and clinical trial participant for Allergan, Inc. [source]

Adipogenic Differentiation of Human Adipose Tissue,Derived Stem Cells Obtained from Cryopreserved Adipose Aspirates

DERMATOLOGIC SURGERY, Issue 7 2010
JUNG EUN LEE MS
BACKGROUND Although frozen adipose tissue is frequently used for soft tissue augmentation, the viability of frozen fat remains a controversy. The cryopreservation of adipose tissue is important for the future use of adipose-derived stem cells (ASCs) and adipocytes. OBJECTIVE To determine whether optimal cryopreservation techniques with regard to the addition of cryopreservative agents and preservation temperature is essential for the long-term storage of adipose tissue and whether ASCs from cryopreserved adipose aspirates are reliable for use in adipogenic differentiation. MATERIALS AND METHODS Adipose tissue was frozen directly or with cryoprotectant at ,20°C or ,80°C for 1 year. The viability of adipose aspirates and the differentiation of ASCs isolated from adipose tissue were evaluated. RESULTS The viability of adipose aspirates frozen with dimethyl sulfoxide at ,80°C was approximately 87% after 2 months of storage. Moreover, ASCs from adipose tissue stored with cryoprotectant survived successfully for 1 year and differentiated into adipocytes, although ASCs were not detected in the directly frozen adipose tissue. CONCLUSION Adipose tissue cryopreserved with cryoprotectant and stored at optimal temperature might prove to be a reliable source of human ASCs and adipocytes. The authors have indicated no significant interest with commercial supporters. [source]

Safety of Lidocaine 15% and Prilocaine 5% Topical Ointment Used as Local Anesthesia for Intense Pulsed Light Treatment

DERMATOLOGIC SURGERY, Issue 7 2010
J. ALASTAIR CARRUTHERS MD
BACKGROUND Literature cautions against applying lidocaine 15%/prilocaine 5% over an area larger than 300 cm2. The area of the face, neck, and chest is 400 cm2 or greater. OBJECTIVE To investigate the safety of lidocaine 15%/prilocaine 5% topical anesthetic ointment used as anesthesia for intense pulsed light (IPL) treatment. METHODS AND MATERIALS Lidocaine 15%/prilocaine 5% ointment was applied to the face only (n=10) for 30 ± 15 minutes or to the face, neck, and chest (n=10) for a total of 60 ± 15 minutes before IPL. Blood lidocaine and prilocaine levels were measured. Adverse events were recorded. RESULTS For the entire cohort, blood was drawn 25.6 ± 6.6 minutes after IPL was completed. In the face only group, the mean lidocaine level was 0.122 ± 0.125 ,g/mL, and the mean prilocaine level was 0.048 ± 0.029 ,g/mL. In the face, neck, and chest group, the mean lidocaine level was 0.272 ± 0.208 ,g/mL, and the mean prilocaine level was 0.087 ± 0.060 ,g/mL. No adverse events related to systemic toxicity were observed or reported to the nurse. At the 24-hour follow-up, no subject reported symptoms of systemic toxicity after leaving the clinic. CONCLUSION Under the conditions of this study, topical lidocaine 15%/prilocaine 5% produces low levels of systemic absorption. The authors have indicated no significant interest with commercial supporters. [source]

Use of High-Frequency, High-Resolution Ultrasound Before Mohs Surgery

DERMATOLOGIC SURGERY, Issue 6 2010
ELLEN S. MARMUR MD
BACKGROUND Although ultrasound imaging is employed ubiquitously today, its use to examine and assess the skin is a relatively new technology. We explored the clinical application and use of high-frequency, high-resolution ultrasound in Mohs micrographic surgery. OBJECTIVE To evaluate the ability of ultrasound to accurately determine lesion length and width of tumor borders in order to reduce the number of surgical stages. METHODS AND MATERIALS This was an institutional review board,approved single-center study of 26 Mohs surgery patients. Ultrasound images were taken to record lesion dimensions, and then the investigator documented clinical estimation of the first stage. Extirpation of the tumor and histological analysis were performed thereafter. RESULTS The results of 20 patients were included in the analysis. A paired-samples t -test revealed no significant difference between clinical and ultrasound widths (t=,1.324, p=.20). Similarly, there was no significant difference between the lengths found from clinical assessment and ultrasound (t=,1.093, p=.29). For different tumor types, there was no significant difference between clinical and ultrasound widths or lengths for basal cell carcinoma (t=,1.307, p=.23; t=,1.389, p=.20) or squamous cell cancer (t=,0.342, p=.73; t=0.427, p=.68). CONCLUSION There is a diagnostic role for high-resolution ultrasound in Mohs surgery regarding the delineation of surgical margins, but its limitations preclude its practical adoption at this time. The ultrasound equipment was loaned to the investigators. Funding for the study was provided by Longport, Inc. [source]

Skin Repair Using a Porcine Collagen I/III Membrane,Vascularization and Epithelization Properties

DERMATOLOGIC SURGERY, Issue 6 2010
FALK WEHRHAN MD
BACKGROUND Collagen membranes have been developed to overcome the problem of limited availability of skin grafts. Vascularization and restricted functional epithelization limit the success of bioartificial constructs. OBJECTIVE To compare the vascularization, epithelization, and integration of a porcine collagen I/III membrane with that of split-thickness skin grafts on skin wounds. MATERIALS AND METHODS In 21 adult pigs, full-thickness skin defects on the rear side of the ear healed by split-thickness skin grafting, by covering with the membrane, or by free granulation. Skin samples on postoperative days 1, 3, 7, 14, 21, and 28 were evaluated histologically (hematoxylin-eosin, Sirius Red) and using immunohistochemistry (cytokeratin 5/6, transforming growth factor beta receptor (TGF,R-III) and immunoblot (TGF,1,3, Smad2/3). Epithelial thickness and TGF,R-III-positive capillary area were quantitatively assessed. RESULTS Epithelization and vascularization in the membrane group were not significantly different from in the group treated with a split-thickness skin graft. Free granulation showed significantly slower epithelization and vascularization (p<.05). TGF,1 and Smad2/3 complex expression were high during free granulation. Matrix was distinguishable until day 7. CONCLUSIONS This membrane serves as a suitable full-thickness dermal substitute, because the membrane is vascularized faster than free granulation tissue and enables early epithelization. Geistlich Biomaterials (Wolhusen, Switzerland) provided the collagen membrane used in this study [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]

Nonvisible Insufficient Subcutaneous Reticular Venous Plexus Can Be Observed through the Skin Using a New Illumination Method

DERMATOLOGIC SURGERY, Issue 2010
LUIS LOPEZ BUSTOS MD
BACKGROUND Insufficient subcutaneous reticular venous plexus (ISRVP) is an overlooked disease because the human eye cannot see many of the insufficient veins. OBJECTIVE To present a total reticular vision (TRV) method that exposes nonvisible ISRVP to normal vision. METHOD & MATERIALS TRV used visual-spectrum white and red light of 700 nm and infrared light of 15 to 850 nm from an ultradigital viewer camera. We studied 124 asymptomatic subjects from the general population without visible ISRVP. Another six patients with ISRVP without other venous pathology were compared with six healthy controls, Very low pressure was applied to the proximal thigh, and minimal volume increments on the medial malleolus were photoplethysmographically registered to validate subcutaneous venous reflux. RESULTS Total reticular vision exposed ISRVP on the lower extremities in 72 of 124 subjects (58%), with observed damaged veins corresponding to more than 90% of nonvisible and 5% of visible portions of ISRVP. Subcutaneous reflux was registered only in patients with ISRVP. CONCLUSION Total reticular vision exposed more than 90% of nonvisible ISRVP, a new pathology, allowing for the study of its relationship with other superficial venous insufficiencies. The authors have indicated no significant interest with commercial supporters. [source]

Visualized Sclerotherapy of Varicose Veins

DERMATOLOGIC SURGERY, Issue 2010
MAMORU KIKUCHI MD
BACKGROUND The spread and movement of sclerosant after injection during sclerotherapy is difficult to monitor. OBJECTIVE To develop a new visualization method that allows monitoring of sclerosant dosage and flow during sclerotherapy. METHODS We used a photodynamic eye (PDE) to perform indocyanine green (ICG) imaging. ICG produces strong fluorescence detectable using PDE and allows monitoring of sclerosant spread through blood vessels in real time. We performed visualized sclerotherapy on 50 limbs, comprising high ligation and sclerotherapy (35 limbs), stripping and sclerotherapy (10 limbs), and sclerotherapy alone (5 limbs). RESULTS In all cases, fluorescence imaging of the injected sclerosant was possible. No complications resulted from combining ICG and polidocanol in any of the patients, all of whom received follow-up evaluations at 1 week, 1 month, and 3 months after treatment. CONCLUSIONS Our new method not only avoids the risk of radiation exposure, but also allows for simple observation of sclerosant range of access, determination of the dosage for each lesion, and accurate administration of therapy to target lesions. This method will contribute to further advances in sclerotherapy, given that it allows administration of sclerosant and visual confirmation of optimal injection dosage, speed, and movement of sclerosant after injection. The authors have indicated no significant interest with commercial supporters. [source]

Treatment of Superficial Infantile Hemangiomas of the Eyelid Using the 595-nm Pulsed Dye Laser

DERMATOLOGIC SURGERY, Issue 5 2010
CHRISTOPHER M. HUNZEKER MD
BACKGROUND Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid. MATERIALS & METHODS Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76,100%), good (51,75%), moderate (26,50%), or poor (0,25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed. RESULTS Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area. CONCLUSION Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid. Roy G. Geronemus, MD, is on the Medical Advisory Board for Candela Laser Corp. [source]

Paradoxical Hypertrichosis After Laser Therapy: A Review

DERMATOLOGIC SURGERY, Issue 3 2010
SHRADDHA DESAI MD
BACKGROUND Laser hair removal is a safe and effective procedure for the treatment of unwanted body hair but is not exempt from side effects. A rare but significant adverse effect with this treatment modality is paradoxical hypertrichosis. OBJECTIVE To evaluate the potential etiologies, risk factors, related laser types, and treatment options for the development of excess hair after laser therapy. MATERIALS AND METHODS An analysis of previously published case studies and review articles along with our own experience was used to gather information regarding this phenomenon. RESULTS Paradoxical hypertrichosis has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. All laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III,VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Treatment for paradoxical hypertrichosis is laser therapy of the affected area. CONCLUSIONS Paradoxical hypertrichosis is a rare side effect of laser hair removal; the pathogenesis of this event remains widely unknown. We recommend further large-scale studies to investigate this effect. The authors have indicated no significant interest with commercial supporters. [source]

Cosmetic Use of Poly- l -Lactic Acid: A Retrospective Study of 130 Patients

DERMATOLOGIC SURGERY, Issue 2 2010
MELANIE D. PALM MD
BACKGROUND Poly- l -lactic acid (PLLA) is an effective treatment for patients seeking to correct volume loss due to aging. Although the Food and Drug Administration has approved PLLA for use in people with the human immunodeficiency virus (HIV), it is well-suited for patients seeking cosmetic treatment. OBJECTIVE To evaluate the efficacy and incidence of adverse events of HIV-negative patients treated with PLLA for volume restoration. MATERIALS AND METHODS This is a retrospective, single-center study of 130 HIV-negative patients treated with PLLA from 2003 to 2008. Patient satisfaction and incidence of adverse reactions were evaluated. RESULTS The most common reaction to PLLA treatment was the formation of nodules (8.5%). Almost all of the nodules were palpable; only one was visible. Treatment areas with the highest incidence of post-treatment nodules were the hands (12.5%) and cheeks (7.2%). Overall, patients were satisfied, with 55% having good to excellent correction; 75% of patients with five or more treatments rated their correction as good to excellent. Sixty-eight percent of all patients would repeat the procedure again. CONCLUSION PLLA is a safe, biodegradable volumizer used to reverse the signs of aging by gradually correcting volume loss. Patients should be aware of possible adverse reactions during the course of treatment. Nodule formation is low, with most patients having good to excellent correction. Drs. Butterwick and Goldman are consultants for Sanofi-Aventis. [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]

Detecting Adverse Events in Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 1 2010
DANIEL PINNEY BS
BACKGROUND Despite increasing awareness of and public attention to patient safety, little is documented about how adverse events (AEs) can or should be monitored in dermatologic surgery. Data to address this shortcoming are needed, although well-defined methodologies have yet to be implemented. OBJECTIVE To summarize current strategies in detecting adverse outcomes of dermatologic surgical procedures. MATERIALS AND METHODS A Medline literature search was conducted using the terms "adverse event,""detection,""reporting,""monitoring," and "surgery." Articles selected addressed the efficacy of one or more AE reporting techniques in surgical patients. RESULTS Prospective and retrospective reporting methods were identified, with morbidity and mortality conference being the most commonly used method of AE reporting. Retrospective medical record review, the retrospective trigger tool approach, and an anonymous electronic reporting system were more sensitive approaches. The Surgical Quality Improvement Program, a program that has successfully translated AE data into lower postoperative morbidity and mortality, was analyzed. CONCLUSIONS Although generally considered safe, dermatologic surgery has no current standard for AE reporting. Standard definitions and high-quality data regarding AEs" currently limit this analysis. Pilot studies are needed to develop feasible measures, with the goal of increasing the sensitivity of AE detection and ultimately improving patient outcomes. The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories. [source]

Skin Tightening Effect Using Fractional Laser Treatment: I. A Randomized Half-Side Pilot Study on Faces of Patients with Acne

DERMATOLOGIC SURGERY, Issue 1 2010
TERUKI DAINICHI MD
BACKGROUND Fractional laser resurfacing is a new procedure for skin rejuvenation. OBJECTIVE To assess the skin remodeling effect of fractional laser treatment. METHODS Twelve Asian patients with acne were irradiated using a fractional 1,540-nm erbium glass laser on a random half of the face twice with a 4-week interval. RESULTS The faces were contoured on the treated side of most patients. Statistical analyses of the facial images showed that the skin tightening effect was significant 4 weeks after the first and second irradiation (p<.001 after both treatments). CONCLUSION These results suggest that fractional laser resurfacing is a possible alternative to nonsurgical skin tightening of the face. The authors have indicated no significant interest with commercial supporters. [source]