Frostbite as a problem for dermatoplastic surgery

An analysis of the 35-years experiences with treatment of 621 patients with the IV-degree frostbite of hands and feet is presented. The surgical strategy of treatment of frostbite has undergone considerable evolution for these years. In addition to classical surgical treatment, the surgeons began to widely use methods of dermo-plastic surgery which allowed not only to save the maximum possible length of the extremity segment stump, but also to reduce the frequency of purulent complications and reamputations and thus to shorten the duration of hospital treatment.     

Pregnancy results from a vibrator application, electroejaculation, and a vas aspiration programme in spinal-cord injured men

In an infertility treatment programme for spinal-cord injured men, vibrator application was primarily used in cases of upper motor neurone lesion and electroejaculation in men with lower lesions, or when vibrator application failed to induce ejaculation. Spermatozoa were obtained by these methods from 29 out of 35 men who desired infertility treatment. No ejaculate was obtained from six men. Three of these men plus two others with very poor sperm quality with electroejaculation underwent micro-surgical sperm aspiration from the vas deferens for invitro fertilization (IVF), and spermatozoa were obtained from all of them. Thus it was possible to obtain spermatozoa from almost every spinal-cord injured man who had ongoing spermatogenesis using these three methods. Insemination was the primary infertility treatment used with all the couples where there was successful ejaculation. In all, 12 pregnancies resulted from home vaginal inseminations, eight from intrauterine inseminations, two from IVF with ejaculated spermatozoa, and two from IVF with spermatozoa aspirated from the vas. Three couples had children from donor inseminations (not counted in the results); 12 are still in the programme. From 24 pregnancies, 22 children have now been born to 18 couples out of the original 35 (51%), and there were four abortions. Hence, overall, infertility treatment of spinal-cord injured men has given good results.     

Treating eating-disorder patients in a managed care environment. Contemporary American issues and Canadian response

This article addresses the effect of managed care on the treatment of eating disorders. We review strategies for negotiating limitations that managed care reviewers place on treatment. Finally, this article reviews the experiences of a Canadian program that has 10 years of experience in providing low-cost day treatment. While change is frustrating and difficult, it is inevitable and can be rejuvenating. These changes offer opportunities for creative development of quality low-cost care. If we do not adjust to these conditions, patients will not get treatment that they need.     

Patient Impairment Lexicon: a psychometric analysis

Growth in managed care has magnified the needs for assessment of treatment efficacies and standardized communication regarding treatment needs. Addressing both needs requires a common terminology describing the scope of treatable mental health impairments. The Diagnostic and Statistical Manual of Mental Disorders-IV provides a common categorical language for describing clinical disorders, but its categories are not discrete and do little to facilitate communication regarding specific treatment needs. Goodman, Brown, and Deitz developed a Patient Impairment Lexicon intended to address these limitations. The current vignette study provided initial psychometric assessment of this nomenclature, specifically examining interrater reliability, temporal stability, and content validity. Findings are discussed with respect to both applications in managed care and psychometric research.     

Dependency scoring in a critical care area: a direct nursing assessment method

The urinary symptoms characteristic of benign prostatic hyperplasia (BPH) can have a considerable impact on patients' quality of life. Symptom score assessment is now used in BPH, although a number of different instruments are available. Controlled clinical trials with selective alpha 1 adrenoceptor antagonists such as doxazosin, prazosin and terazosin have shown these agents to be effective in the treatment of BPH. The effects of doxazosin on the severity and bothersomeness of BPH symptoms were determined in three multicentre, double-blind, placebo-controlled clinical studies, involving a total of 609 normotensive and hypertensive patients. Doxazosin was initiated at a dosage of 0.5 or 1 mg once daily, with a final dose range of up to 12 mg once daily. The duration of active treatment was 12 to 14 weeks. Significant improvements were seen in symptom severity and bothersomeness with doxazosin compared with placebo, in both patient populations. The onset of symptomatic improvement was rapid, occurring within two weeks of treatment initiation, and efficacy was sustained throughout the treatment period. A long-term, open label extension of these studies has demonstrated sustained efficacy during 48 months of follow-up. Since symptom relief is the primary goal of therapy in BPH, and since doxazosin's effects are rapid in onset and sustained in duration, it appears that doxazosin is an effective agent for the treatment of symptomatic BPH in both normotensive and hypertensive men.     

Current trends in onychomycosis therapy: a literature review

Problems with the use of griseofulvin and ketoconazole in the treatment of onychomycosis have led to studies of three new oral antifungal drugs to treat this disease: fluconazole, itraconazole, and terbinafine. These drugs have been superior in relation to a high rate of cure, shorter duration of treatment, minimal adverse effects, and prolonged duration of remission. Although both fluconazole and itraconazole are structurally related to ketoconazole, their triazole ring is more site-specific than the imidazole ring of ketoconazole, which makes these newer drugs less likely to cause liver toxicity. Terbinafine belongs to a new class of compounds called the allylamines, which are fungicidal rather than fungistatic. Terbinafine has become the first line of therapy in Europe and Canada for onychomycosis, and it has recently been approved in the United States in oral form. Itraconazole and fluconazole are available in the United States, but fluconazole is not yet approved for treatment of onychomycosis.     

Squamous cell carcinoma arising from a nonhealing wound and osteomyelitis treated with Mohs micrographic surgery: a case study

The treatment of choice for squamous cell carcinoma arising from chronic ulcer at the lower extremity has traditionally been amputation. Recently, Mohs micrographic surgery has been used as a limb-saving option in selected patients. One of these patients, a 69 year-old white male, presented with a two-year history of a progressive non-healing would and osteomyelitis. A four-month history of an enlarging mass within the ulcer suggested squamous cell carcinoma, which was confirmed by biopsies. The patient was treated with Mohs micrographic surgery for local eradication of the tumor, intravenous antibiotics, and skin grafting.     

Cognitive decline following stroke: a comprehensive study of cognitive decline following stroke

Many patients with Hodgkin's and non-Hodgkin's lymphoma (NHL) can be cured today with combination chemotherapy and/or radiotherapy. However, for patients with suboptimal responses to initial therapy or for patients with refractory or relapsed disease, salvage therapy alone is usually inadequate to achieve long-term survival. High-dose chemotherapy (HDC) with stem cell rescue has emerged as the treatment of choice for such patients as long-term disease-free survival can be obtained in a significant number of these patients. Dose-intensive treatment has been equivocally shown effective for certain patients with Hodgkin's and NHL, whether or not chemosensitivity is shown before transplant. However, HDC has yet to consistently yield durable responses in patients with indolent NHL. Additionally, perhaps the International Prognostic Index can now help identify "high-risk" NHL patients who may benefit from investigative approaches such as frontline HDC.     

A comparison of various estimators of a treatment difference for a multi-centre clinical trial

When a clinical trial is conducted at more than one centre it is likely that the true treatment effect will not be identical at each centre. In other words there will be some degree of treatment-by-centre interaction. A number of alternative approaches for dealing with this have been suggested in the literature. These include frequentist approaches with a fixed or random effects model for the observed data and Bayesian approaches. In the fixed effects model, there are two common competing estimators of the treatment difference, based on weighted or unweighted estimates from individual centres. Which one of these should be used is the subject of some controversy and we do not intend to take a particular methodological position in this paper. Our intention is to provide some insight into the relative merits of the indicated range of possible estimators of the treatment effect. For the fixed effects model, we also look at the merits of using a preliminary test for interaction assuming a 10 per cent significance level for the test. In order to make comparisons we have simulated a 'typical' trial which compares an active drug with a placebo in the treatment of hypertension, using systolic blood pressure as the primary variable. As well as allowing the treatment effect to vary between centres, we have concentrated on the particular case where one centre is out of line with the others in terms of its true treatment difference. The various estimators that result from the different approaches are compared in terms of mean squared error and power to reject the null hypothesis of no treatment difference. Overall, the approach that uses the fixed effects weighted estimator of overall treatment difference is recommended as one that has much to offer.     

The functional activity of the portal vein as a reflection of the metabolic changes in experimental chronic kidney failure

Current therapeutic efforts to treat chronic and progressive neurodegenerative disease include, for the first time, attempts to regenerate affected nervous tissue using neurotrophic factors. The rationale for using trophic factors includes the understanding that they support neuronal survival and regrowth processes. The potential benefits of trophic factor therapy will be no more realized in the near future than in the treatment of amyotrophic lateral sclerosis (ALS). ALS is pathologically characterized by the selective degeneration of specific populations of cranial and spinal motoneurons. Evidence for the existence of factors that support motoneurons has come from studies demonstrating that motoneurons receive trophic influences from various tissues, both central and peripheral, within their local environment. Although the identity of these putative tissue-derived factors has remained enigmatic, recent studies have demonstrated that several previously characterized trophic factors exhibit trophic influences on motoneurons. Among these are several members of the neurotrophin family, most notably brain-derived neurotrophic factor. These neurotrophins meet most of the criteria to be considered motoneuron trophic factors: they are locally available to motoneurons in vivo; motoneurons express specific receptors for these factors; and exogenous application of these factors mimicks the effects of the uncharacterized endogenous agents. The clinical use of these factors for the treatment of ALS, therefore, appears to be scientifically justified.     

Trabeculectomy--success rates in a Singapore hospital

Previously published papers on the success of trabeculectomy as a treatment for glaucoma show success rates between 67% and 84%. The success rate of trabeculectomy in Afro-Carribean patients was observed to be lower than in Caucasian patients. It has been commonly believed that the success rate of trabeculectomy in Oriental/Asian eyes would lie somewhere between these. We reviewed the records of 51 consecutive trabeculectomies performed in the National University Hospital, Singapore and found that our success rate was lower-43.1% overall and 48.7% for primary glaucomas.     

Brief psychotherapy and psychological assessments: Entering a relationship, establishing a focus, and providing feedback.

Brief psychotherapy is aimed at facilitating change within a circumscribed time frame. To do this, therapists in this specialty actively engage clients, establish a focus to the treatment, and provide ongoing feedback throughout treatment. The authors show how using these features of brief psychotherapy in the assessment process can enhance the clinical usefulness of an assessment. By also incorporating an emphasis on respect for the client, in line with existential/client-centered principles, psychological assessments can be made more personally relevant and meaningful for the client. The approach outlined has been useful within a hospital-based, adult inpatient and outpatient mental health service in which assessments are conducted before starting psychotherapy or as clinical activities in themselves (e.g., psychodiagnosis). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cloning and sequencing of a full-length sea bream (Sparus aurata) beta-actin cDNA

The pathogenesis of human African trypanosomiasis (HAT) has been the object of considerable research interest but has remained incompletely understood. The importance of cytokines in the pathophysiology of this protozoan infection is now widely recognized, but the full spectrum of cytokines involved has yet to be determined. In the present investigation we compared the plasma concentrations of TNF-alpha and IL-10 in normal African controls and patients suffering from advanced meningocephalic (late-stage) Trypanosomiasis brucei (T.b.) gambiense infections, before and after treatment with the arsenical trypanocide melarsoprol. We found that patients with late-stage T. b. gambiense exhibit chronically elevated circulating levels of both of these cytokines, and that these levels quickly decline following melarsoprol treatment. These findings confirm that TNF-alpha is involved in the immunopathogenesis of late-stage African trypanosomiasis and suggest that IL-10 may also play an important regulatory role in this disease.     

Sustained response to interferon in a patient with common variable immunodeficiency and hepatitis C

Hepatitis C infection progresses faster in patients with hypogammaglobulinemia, often leading to death from liver failure within 10 yr of exposure. Response to interferon treatment has been poor in these patients. We report the case of a patient with common variable immunodeficiency and hepatitis C in whom a sustained biochemical and viral remission was obtained after treatment with interferon.     

Haemosuccus pancreaticus as a rare initial manifestation of chronic pancreatitis

Twenty-seven painful knee replacements were evaluated arthroscopically. The diagnostic and therapeutic value of these arthroscopic procedures was studied retrospectively. In 5 of the 27 cases, the arthroscopy revealed no diagnosis for the pain. Some form of arthroscopic treatment was performed in 20 cases; in 6 of these 20 cases, however, the treatment did not reduce the pain. Based on these findings, we conclude that the indications for arthroscopic evaluation and treatment of painful knee prostheses are limited.     

HIV protease inhibitory bis-benzamide cyclic ureas: a quantitative structure-activity relationship analysis

A series of N,N'-disubstituted cyclic urea 3-benzamides has been synthesized and evaluated for HIV protease inhibition and antiviral activity. Some of these benzamides have been shown to be potent inhibitors of HIV protease with Ki < 0.050 nM and IC90 < 20 nM for viral replication and, as such, may be useful in the treatment of AIDS. The synthesis and quantitative structure-activity relationship for this benzamide series will be discussed.     

Benign schwannoma of the hand. Considerations on a clinical case

We compared general anesthesia and intravenous sedation-analgesia for SWL on a Dornier HM3 lithotripter with respect to treatment and anesthesia time, X-ray exposure, shockwaves administered, and efficacy. The case records of 49 patients receiving general anesthesia and 118 patients who underwent intravenous sedation-analgesia were examined. Follow-up plain abdominal radiographs were evaluated for residual stones. Treatments accomplished under intravenous sedation-analgesia required less anesthesia time and less SWL time. The amount of fluoroscopy time was increased. The success rate in treating patients with these two types of anesthesia was not significantly different. Intravenous sedation-analgesia is safe and effective for shockwave lithotripsy in the HM3 lithotripter. This technique facilitates more rapid outpatient treatment and has excellent patient tolerance.     

Primary cardiac sarcoma treated by orthoptic cardiac transplantation. Apropos of a case

The authors report a new case of cardiac sarcoma treated by cardiac transplantation. This treatment has been proposed for these malignant tumours of poor prognosis when simple excision is impossible, with variable results. This patient is in good general condition 20 months after transplantation. Transplantation is a therapeutic procedure which should be considered in malignant tumours limited to the heart.     

小型生活污水处理设备的设计与研究

采用BIOFOR设备处理小型生活污水的最佳运行条件为V（气）：V（水）为4：1、pH值为7～8,此时COD去除率为70％～86％,出水水质可以达到《城镇污水处理厂污染物排放标准》（GB18918-2002）一级B标准。该工艺适合人口分布分散的边远矿山和农村地区,能有效控制我国小集镇和农村生活污水点源污染问题,对大力推动新农村建设具有积极意义。     

Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements

The purpose of this review is to present current information from the literature regarding the pathoanatomy, clinical presentation, differential diagnosis, treatment, and outcome assessment methods for patients with lumbar spinal stenosis. Lumbar spinal stenosis is a frequently encountered condition, particularly in the elderly. Treatment requires an accurate diagnosis, but differential diagnosis of lumbar stenosis can be difficult. The literature to date has focused primarily on surgical treatment. The long-term efficacy of surgery has been questioned, and surgical procedures are associated with increased costs and risks of morbidity in an elderly population. A trial of conservative care is recommended in most cases, but there are presently no randomized controlled studies in the literature comparing surgical versus conservative management, or evaluating the effectiveness of any specific conservative treatment approach. The existing literature has further been criticized for having poorly defined outcome measures. The assessment of treatment outcomes should be multifactorial, including measures of pathoanatomy and impairments, as well as patient-centered measures such as level of disability, patient expectations, and satisfaction. The present level of understanding of lumbar spinal stenosis is deficient in many areas, including differential diagnosis, treatment, and outcome assessment. Future research should address these deficits to improve the management of patients with this condition.