Onychomycosis: diagnosis and systemic treatment

Onychomycosis, a persistent fungal infection affecting the toenails and fingernails, can interfere with standing, walking, and exercising. Associated physical impairments can result in paresthesia, pain, discomfort, and loss of manual dexterity. Patients may also suffer from loss of self-esteem and social interaction. A definitive diagnosis is crucial for effective treatment, because many other skin and nail disorders mimic onychomycosis. Diagnosis involves microscopic potassium hydroxide preparation, cultures, nail biopsy, and histologic analysis. Treatment can include topical and systemic antifungal therapies as well as nonpharmaceutical methods. This paper discusses pathophysiology, diagnosis, and treatment options for this common nail dystrophy, including the newer antifungal medications now available.     

Response of segmental vitiligo to 0.05% clobetasol propionate cream

New antifungals for oral therapy have improved the chances of healing onychomycoses. Nevertheless, in daily practice the failure rate is 20-30% both with itraconazole and terbinafine. In our investigations for the fungicidal effects of terbinafine, we could show that the same strain of Trichophyton rubrum or T. mentagrophytes in the rest period needs 1000 times higher concentration of terbinafine (2.0 to 0.002 microgram/ml) for complete fungal killing as in the growth phase. Thus resting fungi in the nail are not harmed, and if the concentration of terbinafine is lower than the MIC for the fungi, they can cause a relapse. Itraconazole is a fungistatic agent. Its concentration in the nail plate must be higher than the MIC for the causative fungi for a long time-10 to 12 months. The usual short-term treatment of onychomycosis over 3 months can be insufficient in individual cases such as patients with disorders, e.g. circulatory disorders or slowed nail growth.     

Infantile psoriasis

We report 14 infants younger than 2 years of age with psoriasis vulgaris in order to call attention to the existence of infantile psoriasis. Three of the patients were noted to have psoriasis in the neonatal period; the onset may have been prenatal in one. In 13 of the 14 patients the site of onset was determined by the isomorphic effect (K?bners phenomenon). Although nail pitting is usually said to be infrequent in childhood psoriasis, 11 (79%) of our patients had typical psoriatic nail changes. Psoriasis must be considered in the differential diagnosis of papulosquamous disorders in infants.     

Working conditions, living conditions and physical health problems declared among penitentiary administration personnel in France

A cross-sectional epidemiological survey was conducted among prison staff in France to investigate the relationships between working conditions and health. The sample included men and women 20 to 64 years old belonging to all categories of prison personnel: prison guards, administrative staff, socioeducational workers, technicians, health care workers, and managers (n = 4587, response rate 45.7%). A mailed self-administered questionnaire was used to assess sociodemographic characteristics, working conditions, and physical and mental disorders. Multiple logistic regression analyses were conducted to determine the effects of working conditions and social relationships on health of prison staff. However, the results reported here only concern 17 health disorders: body mass index, sick leave, medication use, accidents, digestive disorders, lower extremities and back disorders, hypertension, hemorrhoids, arthritis, skin disorders, urinary infections, chronic bronchitis, cholesterol, gastric ulcer, respiratory infections, ocular disorders. The living non professional conditions mostly associated with health disorders were financial difficulties (OR: 1.9 for digestive disorders, 1.8 for gastric ulcer, 1.7 for medication use) and irregularity of meals (OR = 1.5 for digestive disorders, and hypertension). In the occupational environment, the factors most associated with health disorders are seniority (OR = 4.2 for arthritis, 2.3 for cholesterol) and constraints (OR = 1.7 for lower extremities disorders). In spite of some limits associated to this kind of study, relationships between occupational and non occupational factors and physical health conditions were observed; the results also pointed out the protective role of the social relationships for health conditions.     

Pyridostigmine bromide and Gulf War syndrome

A problem arose when the reamed tibia nail was replaced by a massive unreamed tibia nail. Of the nail fractures, it is difficult to remove the distal fragment from the medullary cavity. It may also happen that the connecting screw between the insertion handle and the nail breaks off at the edge of the implant, which complicates removal of the nail. The authors have developed a technique for removing the implant without having to saw a fissure in the marrow. A concave instrument is slid over the part of the nail left behind after which the two are connected by means of a K wire. This method has been successfully applied in two patients.     

Failure of femoral head fixation: a cadaveric analysis of lag screw cut-out with the gamma locking nail and AO dynamic hip screw

The most commonly reported failure mode of sliding hip screws in published literature is cut-out of the lag screw. This study investigates the resistance to failure of the femoral head, with lag screws used in two types of sliding hip screws, the gamma locking nail (Howmedica) and the dynamic hip screw (DHS) (Synthes). The investigation consisted of biomechanical tests under static loading conditions on 12 pairs of cadaveric femoral heads, to establish the failure loads due to screw cut-out for the two implant lag screws. The gamma nail appeared to reduce the tendency to cut-out in the osteoporotic bone (soft) associated with elderly patients in whom these devices are commonly used (p < 0.05). In high density bone (hard) the gamma lag screw also appeared to be stronger, because the DHS showed a tendency to bend. The larger diameter of the gamma nail lag screw resists bending and appears to reduce the risk of cut-out compared with the DHS.     

Mitral valve prolapse syndrome. Arrhythmia, abnormalities of the ventricular contraction and dysfunction of the autonomic nervous system

A new instrument has been developed and used to determine the effect of various materials on nail flexibility. It repeatedly flexes longitudinal nail sections through 90 degrees and records the number of flexions required to fracture each section. Immersion in water or a phospholipid-water preparation (PLW) greatly increases the flexibility of untreated and lipid extracted nails; immersion in mineral oil does not. Nail flexibility is directly related to the duration of their immersion in water. During water immersion, nail weight increases by 22% of its original weight within 2 h, and then decreases. The rapid increase in nail flexibility during water immersion is related to nail water content. It is possible to prolong the flexibility of previously hydrated nails by the application of PLW or mineral oil. PLW is more effective than water alone in prolonging flexibility of nails extracted with a mixture of acetone, water and acetic acid.     

Anxiety, depression, and diseases of the lower extremities

There are many physical disorders that have little or no organic basis. Many of these conditions are caused by mental pathology. Certain emotional disorders can magnify the person's ability to perceive pain. Anxiety and depression are often the culprits. It behooves the podiatrist to be aware that anxiety and depression can be a cause of foot and ankle pain or that they can exacerbate true physical symptoms. The podiatrist should be able to perform a rudimentary psychological evaluation in the outpatient clinical setting, and should be prepared to make a timely and proper referral to a mental health professional for additional testing and treatment.     

土钉支护及其应用

土钉支护是一种用于土体开挖和边坡稳定的新型支挡结构，具有良好的延性破坏特征。通过土钉支护在济钢中厚板厂二期工程中的应用实例，介绍了土钉支护的局部和整体稳定性计算及工程设计方法，并指出土钉支护应注意的问题。     

Hearing, speech, language, and vestibular disorders in the fetal alcohol syndrome: a literature review

Fetal alcohol syndrome (FAS) is characterized in part by mental impairment, as well as craniofacial and ocular anomalies. These conditions are traditionally associated with childhood hearing disorders, because they all have a common embryonic origin in malformations of the first and second branchial arches, and have similar critical periods of vulnerability to toxic insult. A review of human and animal research indicates that there are four types of hearing disorders associated with FAS. These are: (1) a developmental delay in auditory maturation, (2) sensorineural hearing loss, (3) intermittent conductive hearing loss due to recurrent serous otitis media, and (4) central hearing loss. The auditory and vestibular systems share the same peripheral apparatuses (the inner ear and eighth cranial nerve) and are embryologically and structurally similar. Consequently, vestibular disorders in FAS children might be expected. The evidence for vestibular dysfunction in FAS is ambiguous, however. Like other syndromes associated with craniofacial anomalies, hearing disorders, and mental impairment, FAS is also characterized by a high prevalence of speech and language pathology. Hearing disorders are a form of sensory deprivation. If present during early childhood, they can result in permanent hearing, language, and mental impairment. Early identification and intervention to treat hearing, language, and speech disorders could therefore result in improved outcome for the FAS child. Specific recommendations are made for intervention and future research.     

The International Classification of Functioning, Disability and Health: Contemporary Literature Overview.

This article reviews the literature from the 3 years since the International Classification of Functioning, Disability and Health's (ICF's) endorsement, focusing on those articles that discuss (a) what the ICF means and how it can be used; (b) the general utility of the ICF for specific fields, such as nursing, occupational therapy, speech-language pathology, and audiology; (c) examples of applications for classification in particular disorders, such as chronic health conditions, neuromusculoskeletal conditions, cognitive disorders, mental disorders, sensory disorders, and primary and secondary conditions in children; (d) uses of the ICF to recode prior work across multiple surveys and across country coding schemes on disability-related national survey items; and (e) governmental uses of the ICF in the United States and selected countries abroad. Future directions needed to effectively implement the ICF across rehabilitation policy, research, and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organic causes of dyspepsia, and discriminating functional from organic dyspepsia

A wide variety of disorders affecting the upper gastrointestinal tract, as well as systemic disorders, are associated with symptoms of dyspepsia. The more important of these conditions are considered in this chapter, with particular reference to their symptom patterns on presentation. The differentiation, on clinical grounds, between these organic causes of dyspepsia and functional dyspepsia remains an important area of research. Those aspects of the history and physical examination most relevant to this distinction are also considered.     

Relaxation therapy, biofeedback, and behavioral medicine.

Discusses the major forms of relaxation and biofeedback and describes the current applications for such conditions as pain, cardiovascular disorders, and neurological abnormalities. It is asserted that while relaxation is not a panacea for all medical problems, it has proven to be a useful adjunct to traditional medical treatments for such medical disorders as chronic pain, hypertension, migraine headache, Raynaud's disease, and epilepsy. In some conditions, such as muscle-contraction headache, relaxation therapy and/or biofeedback is the treatment of choice. Relaxation may be considered a cognitive coping skill that is more a preventive procedure than just a technique to modify specific physiological responses. It is noted that since the field of behavioral medicine involves the integration of behavioral and biomedical science knowledge and the application of this knowledge to prevention and treatment to disease, the boundaries of psychology and medicine are no longer sharply defined. (78 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the modified gamma nail and the ender nail for treatment of intertrochanteric fractures

We made a comparison between the modified Gamma nailing and the Ender nailing in the treatment of 102 patients with intertrochanteric fracture. Sixty patients were treated with the modified Gamma nailing and forty-two patients with the Ender method. The preoperative conditions of the patients in the two groups were similar as showed by statistical analysis. More intraoperative bleeding was recorded in the modified Gamma nail group. However, there were a earlier full weight -bearing, a better hip function and a lower rate of operative complication in the patients treated with the modified Gamma nailing. We conclude that with the modified technique and the modified femoral component the Gamma nail is advanced in the treatment of intertrochanteric fracture. However, it is danger to apply in elderly patients accompanied with certain vital problems. For these patients the Ender nail may be considered.     

Beta 2-adrenergic receptor and angiotensin II receptor modulation of sympathetic neurotransmission in human atria

BACKGROUND: Cultures of epidermal cells are commonly used to study skin biology and differentiation. Recently a method to culture nail matrix cells has been established. OBJECTIVE: We report the biologic characteristics of nail matrix cells in vitro compared with those of epidermal keratinocytes. METHODS: Human nail matrix cells were isolated and cultured in defined medium. Electron-microscopic examination, growth rate, integrin expression and keratin synthesis pattern were evaluated. In addition, the cells were cultured in serum-containing medium. RESULTS: Nail matrix cells appear to be larger than human epidermal keratinocytes and, at the ultrastructural level, they contain a higher euchromatin/heterochromatin ratio and a lower nucleus/cytoplasm ratio and have a higher growth rate. The synthesis of "hard" keratins was detected at all calcium concentrations. Immunofluorescence analyses showed the expression of alpha 2, alpha 3, and alpha 6 integrin subunits. When cultured in serum-containing medium, nail matrix cells produced an outgrowth of epithelium and a spontaneous migration phenomenon associated with a tendency to stratify in a semilunar area that resembles the architecture of the nail matrix. The pluristratified epithelium showed characteristic markers of nail differentiation. CONCLUSION: Culture of nail matrix cells may represent a useful model to study the biologic properties of nail structure, alterations in some nail diseases and the effects of drugs.     

Behavior of Calculated Nail Head Strength in Soil-Nailed Structures

Nail head strength is one of the parameters used in design of soil-nailed structures. It determines the stability of the nailed structure against failure involving the facing element. The nail head strength is a function of a number of factors, primarily the material strengths, vertical and horizontal nail spacing, and the nail head connection details. The variations in nail head strength as a result of changes in the vertical and horizontal soil-nail spacing and material strength properties are examined in this paper. Both temporary and permanent facing design is considered. For equal vertical to horizontal spacing, the nominal nail head strength for a temporary facing decreases continuously as the spacing is increased. The nominal nail head strength for permanent facing decreases initially and then remains nearly constant. For a fixed vertical spacing (Sv) the nail head strength for temporary facing decreases linearly as the horizontal spacing (Sh) increases. For permanent facing the nail head strength decreases very slowly for vertical to horizontal nail spacing ratio between 0.8 and 1.0 and then declines rapidly. The nail head strength increases most rapidly with increase in facing thickness. Higher strength reinforcement and concrete have a relatively smaller influence in raising the nail head strength. Charts are presented that can help in optimizing the design of soil-nailed structures.     

Supplementation of coconut oil from different sources to the diet induces cellular damage and rapid changes in fatty acid composition of chick liver and hepatic mitochondria

PURPOSE OF THE STUDY: Impaction in pertrochanteric fracture sites is a well known phenomenon; the screw-plate system is designed to stabilise the fracture. Although easier to use, the risk with the nail-plate system is postoperative penetration of the nail into the joint. The present study was conducted to determine the exact conditions of the impaction, and to identify possible ways to improve the nail-plate system. MATERIAL-METHOD: The study included 129 cases of pertrochanteric fracture, excluding sub-trochanteric fractures. All fractures were fixed with a 130 degrees angulated nail-plate. In all cases, consolidation was uneventful after 8 to a 12 weeks. The anatomical type of fracture, i.e. stable or unstable, was determined according to the size of the intermediary fragment, including the trochanter minor. The displacement was measured as the difference between the length of the nail and the length of the femoral head and neck measured along the axis of the femoral neck. The parameters examined were: fracture stability degree, bony mineralisation (Singh Index), nail length, femoral neck, length nail position in the femoral head, and above all, fracture reduction. All these parameters were computerised and compared using Stat View statistics software. RESULTS: Impaction was observed in 43 per cent of cases. Among these, 25 per cent were rated as slight (1 to 5 mm), 18 per cent as moderate (over 5 mm) and 9 per cent as marked (10 to 25 mm). Impaction was associated with demineralisation of the bone tissue (p = 0.001). The anatomical classification of the fracture was not a determining factor (p = 0.19), as marked displacements were also recorded in stable fractures. A posterior and inferior position of the intramedullary nail in the femoral head is one of displacement determining factors (p = 0.004, two-sided 1 test). Valgus over-correction is the most important factor, especially when it is associated with bony demineralisation (p = 0.02) and an inadequately centred intramedullary pin (p = 0.02). Shorter the femoral neck, and shorter the nail, greater was the frequency of nail articular penetration. DISCUSSION: The risk of articular penetration therefore reaches 15 per cent in petrochanteric fractures repaired with a nail plate, set at an angle of 130 degrees. A short neck, a cervicodiaphyseal angle superior to 140 degrees, and demineralisation are the three determining parameters. Stable or unstable fracture has in fact little effect on displacement incidence, and therefore does not, on its own, warrant the use of a prosthesis in comminuted fractures. The authors compared their results to literature on progressive sliding system: the incidence of complications associated with this type of fracture treatment is identical, but the determining parameters are different. CONCLUSION: The study shows that the nail-plate is efficient and provides simple and solid fracture fixation. However, this osteosynthesis material needs to be modified in order to improve its fixation in the femoral head.     

Various possibilities for managing subtrochanteric fractures

Subtrochanteric fractures are highly unstable. For treatment, open reduction and internal fixation are the method of choice. The 95 degrees condylar plate is widely used for stabilization of these fractures. Alternative devices are the gamma nail and the recently developed intramedullar nail with a twisted plate which allows immediate postoperative weight bearing. The reported complications of the gamma nail restrict its general application, whereas preliminary reports of the intramedullar nail with the twisted plate are encouraging. Further clinical data are necessary before its general application can be recommended.