Oral treatment options for onychomycosis

The author discusses the new oral antifungal agents for the treatment of onychomycosis. The history, mechanisms of action, efficacies, dosing, safety profiles, and costs of itraconazole, terbinafine, and fluconazole are reviewed. The author emphasizes that use of these effective antifungals represents an important paradigm shift for podiatric physicians away from the palliative therapy of nail debridement to a potentially curative treatment.     

Inferential and advanced analysis of research data

This study was undertaken to determine which biomedical journals contain articles written by podiatric physicians and in which indexing sources such articles are likely to appear. A survey was conducted of the 20 most frequently published podiatrist authors from a selected group of podiatric journals during the period from 1990 to 1995. Articles published by these authors during the study period were examined to determine where they had appeared. The MEDLINE database was found to contain the largest number of citations to articles written by these podiatric physicians. Both the Podiatry Index and Embase are also very good sources of citations to podiatric medical literature and should be used to supplement MEDLINE searches.     

Streptococcus pneumoniae-induced hemolytic uremic syndrome: a case for early diagnosis

The Mitek Mini GII anchor is showcased as a relatively new device that provides a rapid, simple method for bony reattachment; here, it is introduced for the fixation of flexor or extensor tendons at their insertion. Transosseous tunnels with limited visualization, pull-out sutures, and external devices can now be avoided if desired. Applications for soft-tissue fixation should in no way be limited to the small bones of the hand. Expense of the apparatus remains its only major drawback.     

Atopy and reaction to nail dust inhalation

Inhalation of nail dust is a chronic problem facing podiatric physicians. This problem is compounded in physicians who develop allergic reactions to nail dust. This article defines atopy, reviews the characteristics of nail dust, and suggests methods to reduce the potential hazard that nail dust presents to the podiatric physicians and their employees.     

Rewards of entering podiatric medicine and attitudes toward older adults

This study examined the relationships between social and demographic characteristics (ie, gender, race, year in school, desired residency choice, and socioeconomic background), motivations for entering the profession of podiatric medicine (extrinsic and intrinsic rewards), and negative attitudes toward treating elderly patients. The study used ordinary least squares multiple regression models to analyze data from a random, national sample of 448 podiatric medical students. In particular, the ordinary least squares models were developed to determine the independent effect of intrinsic and extrinsic rewards on negative attitudes toward treating elderly patients. Consistent with the study hypotheses, after adjusting for social and demographic characteristics, the study found extrinsic rewards to have strong positive relationships with negative attitudes toward treating elderly patients, and intrinsic rewards to have strong negative relationships with negative attitudes toward treating elderly patients. The authors discussed the implications of the findings for podiatric physicians and educators training podiatric medical students.     

Transosseous transposition of a pedicled rectus abdominis flap to cover hip wounds

Bone-marrow transplantation may be complicated by aseptic necrosis of the femoral head. Prolonged immunosuppression places the patient at increased risk of infection and is of particular concern if replacement arthroplasty is contemplated. Infection of a prosthesis usually requires thorough debridement and removal of the device. However, attention must also be paid to the resultant cavity and soft-tissue cover. Several flaps have been reported for this problem, though limitations of flap size may make it difficult to achieve both objectives. This report describes the use a pedicled rectus abdominis flap that was tunnelled through the acetabulum in order to gain direct access to the hip and allow adequate length both to fill the dead-space and to provide cover.     

Blood pressure and left ventricular mass in children with different maternal histories of hypertension: the Hypertension in Pregnancy Offspring Study

The treatment of chronic, nonhealing wounds is discussed. The authors have successfully utilized locally acting growth factors as an adjunct to aggressive, comprehensive management in a clinical setting. At the Holmes Regional Wound Care Center, wounds with an average duration of 75 weeks at presentation were 100% epithelialized in an average of 10 weeks of therapy. The use of topical PROCUREN, or autologous platelet-derived wound healing factors (PDWHF) is introduced to the podiatric literature.     

Skin expansion screw and skin expander--modern techniques for increasing possibilities in adjacent flap-plasty and defect closure

There are various techniques for reconstructing skin and soft-tissue defects, among them skin expansion. During the past three years, we have tested a skin-stretching device based on the lag-screw principle of Hirshowitz et al. (1993). We have compared both techniques. The complication rate of both groups was acceptably low.     

Evaluation of expanded polytetrafluoroethylene as a soft-tissue filling substance: an analysis of design-related implant behavior using the porcine skin model

Soft-tissue augmentation using the synthetic nonfluid biomaterial expanded polytetrafluoroethylene (ePTFE) has been supported by number of recent reports citing the favorable characteristics of biocompatibility, soft and natural feel, ease of use, and permanent augmentation. Concern has been expressed about this application for ePTFE material because of the proximity of the implants to the skin surface and potential problems with infection and extrusion. We evaluated the behavior of a series of specific ePTFE implant designs using a long-term subcutaneous augmentation model. By using a porcine model, 466 implants of ePTFE in the form of strips, rolls, or tubes were placed using a percutaneous insertion device subcutaneously over the dorsum and face. The animals were divided into three study groups by length of implantation (3 weeks, control; 6 months, intermediate term; and 12 months, long-term) and en-bloc tissue specimens, including skin, implants, and underlying soft tissue, were harvested for gross and histologic examination. Implants were removed at the earliest sign of infection, exposure, or extrusion and the difficulty of removal was ascertained and recorded. These data reveal that ePTFE material elicits acceptable levels of tissue activity with low extrusion rates over the short and long term supporting its use for soft-tissue augmentation. The data show a clear difference, however, in the host response and behavior of the implants for this application based on shape or design. A statistically significant difference in the low, but measurable, extrusion rates was observed amongst these implant designs. ePTFE tubes showed greater stability and predictable augmentation over other implant designs for soft-tissue augmentation and seem to represent a substantial improvement for this application.     

Prognostic factors for surgical treatment of soft-tissue sarcomas in dogs: 75 cases (1986-1996)

OBJECTIVE: To determine results of surgery for treatment of soft-tissue sarcomas in dogs and to identify prognostic variables that can be used to predict outcome. DESIGN: Retrospective case series. ANIMALS: Dogs with soft-tissue sarcomas that had surgical treatment only. PROCEDURE: Records were examined for clinically relevant data. Histologic samples were reviewed. Follow-up information was obtained by physical examination or telephone conversations with referring veterinarians or owners. RESULTS: 75 dogs with soft-tissue sarcomas of the trunk and extremities were identified. Median age was 10.6 years. Malignant peripheral nerve sheath tumors were of a significantly lower grade than other tumors. Tumors recurred locally in 11 of 75 (15%) dogs. Evaluation for lack of tumor cells at surgical margins was prognostic for local recurrence. Metastatic disease developed in 13 of 75 (17%) dogs. Tumor mitotic rate was prognostic for development of metastasis. Twenty-five of 75 (33%) dogs died of tumor-related causes. Percentage of tumor necrosis and tumor mitotic rate were prognostic for survival time. Median survival time was 1,416 days. CLINICAL IMPLICATIONS: On the basis of a low local recurrence rate and high median survival time, wide excision of tumor margins or radical surgery appeared to be an effective means for managing soft-tissue sarcomas of the trunk and extremities. Analysis of histologic characteristics for prognosis supported use of preoperative biopsy. Surgical margins should be evaluated, and early use of aggressive surgery is indicated in the management of soft-tissue sarcomas in dogs.     

Use of provisional restorations to enhance soft-tissue contours for implant restorations

The objective of restoring missing teeth with implant-supported restorations should not merely be achieving osseointegration with an implant and a biomechanically sound restoration. The objective must be the esthetic and functional restoration of the missing teeth. To achieve this, proper treatment planning is critical. Precise implant placement and delicate soft-tissue manipulation during surgery will allow the restorative dentist to enhance the peri-implant soft-tissue contours with the use of provisional restorations. Empirically, it seems that the earlier the provisional restoration is delivered in the treatment process the more ideal the esthetics. Several methods of using provisional restorations to enhance soft-tissue contours are presented. The concept of immediately delivering provisional restorations on placement of an implant is discussed.     

The podiatric examination

With the evolution of the AIDS epidemic into a relatively chronic disease, practitioners will continue to see an increase in the number of patients infected with HIV for the diagnosis and management of podiatric pathology. A thorough history and physical examination, taken with a complete knowledge base of HIV implications, will enhance the ability to form the strategies required to treat the manifestations of this disease and to request appropriate referrals. Laboratory studies and other diagnostic techniques have been developed and increased in specificity to allow for earlier and more precise identification of the presenting pathology. A continuously expanding choice of medications is available for treatment. The clinical presentations of HIV infection in the foot involve nearly all organ systems. This article reviews the podiatric role as part of the medical team in the diagnosis and treatment of patients infected with HIV.     

Onychomycosis. Baseline results of an observational study

The investigators present an analysis of baseline quality-of-life and patient-management approaches from an observational study of 150 patients being treated by podiatric physicians and dermatologists for onychomycosis. The majority (73%) made the initial office visit specifically because of their onychomycosis. Both men and women indicated that they had substantial physical discomfort as well as concerns related to appearance. Women reported significantly more problems than did men as a result of their onychomycosis. Physicians reported that 54% of patients suffered from toenail discomfort, 36% had pain while walking, 40% reported that their condition limited wearing of shoes, and 67% were embarrassed by the condition. The results of this study suggest that the treatment approach of podiatric physicians is more likely to address the palliative concerns of patients with onychomycosis, while the approach of dermatologists is more likely to attempt a definitive cure.     

Polydactyly of the foot. Overview with case presentations

The authors offer two unique case presentations of pedal polydactyly as well as a general discussion of this congenital anomaly. This presentation demonstrates how a common condition has very individualized treatment plans that are based on communication between the patient and the podiatric surgeon.     

Anchoring errors in clinical judgments: Type I error, adjustment, or mitigation?

The nature of anchoring errors in clinical judgments was clarified. Study 1 tested if gender mediates the occurrence of anchoring errors. Judgments from 103 undergraduate psychology students evidenced neither anchoring errors nor gender differences. Given the inability to replicate M. L. Friedlander and S. J. Stockman's (see record 1983-31114-001) study, two rival hypotheses were advanced: the adjustment hypothesis (practitioners adjust appropriately their clinical judgments after receiving new client information) and the adjustment mitigation hypothesis (initial anchoring effects are mitigated by an adjustment effect). The judgments from 157 psychologists in Study 2 affirmed the adjustment and mitigation hypotheses over the anchoring hypothesis alone. The mitigation process appears adaptable in clinical judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Baseline characteristics and therapeutic goals in the New Approaches to Coronary Intervention (NACI) registry

BACKGROUND: The New Approaches to Coronary Intervention (NACI) voluntary registry was designed to study the use, safety, and efficacy of new percutaneous transluminal interventional devices including directional coronary atherectomy, the transluminal extraction catheter, the rotablator, the Palmaz-Schatz stent, the Gianturco-Roubin stent, the Advanced Interventional Systems (AIS) laser, and the spectranetics laser. METHODS: To date, more than 3800 consecutive patients treated for the first time with a new device at 41 centers have been entered into the registry. Complete detailed information about the patient, lesions, device characteristics, reasons for device selection, and procedural data, such as adjunctive use of conventional balloon angioplasty (PTCA), was available for the first 2835 patients. RESULTS: The registry shows that 88% of the 3233 attempts with a new device were intended as a definitive treatment of target lesions, frequently in combination with adjunctive PTCA. The remaining 12% of attempts with a new device were unplanned, prompted by unexpected complications, unsuccessful attempts, or suboptimal results with PTCA. Although there was some overlap in the indications for selecting a given interventional device, the variation from device to device was sufficiently large to caution users against any direct comparison of either safety or efficacy between devices without careful attention to the differences in baseline patient and lesion characteristics, treatment plans, and the circumstances of device use. CONCLUSION: This report provides the first comprehensive overview of how new interventional devices are currently being used in the treatment of coronary artery lesions at the 41 centers participating in the NACI registry.     

Elderly, poor, solitary and marginal patients: geriatric vulnerability in emergency services

Although tetanus is a preventable disease, several cases are reported to the Centers for Disease Control and Prevention each year. Many conditions treated by podiatric physicians carry the risk of infection by Clostridium tetani, and it is advisable for podiatrists to update a patient's tetanus immunization status if the patient presents with a tetanus-prone wound.     

An anchoring theory of lightness perception.

A review of the field of lightness perception from Helmholtz to the present shows the most adequate theories of lightness perception to be the intrinsic image models. Nevertheless, these models fail on 2 important counts: They contain no anchoring rule, and they fail to account for the pattern of errors in surface lightness. Recent work on both the anchoring problem and the problem of errors has produced a new model of lightness perception, one that is qualitatively different from the intrinsic image models. The new model, which is based on a combination of local and global anchoring of lightness values, appears to provide an unprecedented account of a wide range of empirical results, both classical and recent, especially the pattern of errors. It provides a unified account of both illumination-dependent failures of constancy and background-dependent failures of constancy, resolving a number of long-standing puzzles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A "smart needle" to facilitate difficult vascular access in pediatric patients

A new Doppler probe inside a needle was evaluated in a group of infants and children to assess its suitability for subclavian venous access. While the efficient use of this device required learning a new technique, we found the device useful to accurately locate the subclavian vein and differentiate it from the artery in all patients weighing more than 3 kg. This device will be most helpful in cases of difficult access, eg, scar from previous access, obesity, or edema.     

The use of cyanoacrylates in periodontal therapy

N-butyl cyanoacrylate is an effective tissue adhesive which is hemostatic and bacteriostatic. It can be considered an alternative to conventional sutures in soft-tissue surgery. The author presents two cases demonstrating the use of the material. Case One shows its use in free gingival graft surgery. Case Two shows its use post-biopsy.