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.     

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.     

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.     

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.     

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.     

Flashlamp pulsed dye laser (585 nm). Treatment of resistant verrucae

The treatment of recalcitrant plantar verrucae has represented challenging clinical problems for podiatric physicians. A procedure described by Borovoy et al studying 46 patients initially indicated a success rate of 76.1%. A review of 200 patients who have been treated with refined treatment protocols and modalities is presented, with an overall success rate of 79.9%. The Candella SPTL 1 and 1B have been used in the study. These lasers produce a full 450-microsecond pulse at 585 nm wave length. Hand pieces ranging from 2 mm to 7 mm were used. The energy density (fluence) used ranged from 6 to 9 J/cm2. Discussion will be presented including treatment protocol, modalities, comparisons with other forms of treatment, and overall success rates.     

Difficulty in removal of certain intramedullary nails

Intramedullary nailing is the most common treatment for displaced diaphyseal fractures of the femur and tibia. Gerhard Küntscher introduced the technique of intramedullary nailing to clinical practice in the 1940s, and this method has been the focus of many authors with regard to indications, technique, complications, and outcome. The five cases presented here represent a complication not often reported in recent years: the difficulty in removing an intact intramedullary nail. Inspection of the interlocking nails in four of the cases presented reveals a specific design characteristic: the cross sectional design of the nail prevents the distal, unslotted end of the nail from being extracted from the medullary cavity. This problem is preventable by a change in nail design or the development of absorbable implants.     

Onychomycosis

The prevalence and clinical types of onychomycosis and diagnostic methods are reviewed in this article. The need for correct identification of the causative organism is emphasized. The use of oral and topical therapeutic agents is outlined, with specific emphasis on relevant research data and potential side effects of these agents. Sections on the potential hazard of nail dust, onychomycosis in HIV-infected patients, and the long-term management of onychomycosis are also included.     

Sildenafil (Viagra) for treating male erectile dysfunction

Many procedures performed by podiatric surgeons today require the use of a soft-tissue anchoring device. In recent years, many new anchoring devices have become available for use in the foot and ankle. The authors introduce a new soft-tissue anchoring device that has yet to be described in the podiatric literature and present two cases in which the new anchor was used.     

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.     

氧气转炉烟气干法净化技术及应用

氧气转炉炼钢的干式布袋除尘工艺，近年来有了一定的发展。这种工艺是将转炉高温烟尘混入大量冷空气，增大燃烧系数，降低烟气温度，再通过耐高温滤料布袋除尘器脱除烟气中的灰尘。与湿式“二文一塔”法除尘相比，具有系统压力损失小，生产费用低和除尘效率高等优点，且没有湿式所带来废水、泥浆的处理和泥浆的存放问题，并有利于实现负能炼钢，这种工艺技术对我国冶金环保具有推广价值。     

Diabetic foot ulcers: prevention, diagnosis and classification

Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. The most common risk factors for ulcer formation include diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease. A careful physical examination, buttressed by monofilament testing for neuropathy and noninvasive testing for arterial insufficiency, can identify patients at risk for foot ulcers and appropriately classify patients who already have ulcers or other diabetic foot complications. Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation. Adherence to a systematic regimen of diagnosis and classification can improve communication between family physicians and diabetes subspecialists and facilitate appropriate treatment of complications. This team approach may ultimately lead to a reduction in lower extremity amputations related to diabetes.     

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.     

干法除尘系统大灰仓优化设计与应用

为解决干法除尘系统除尘灰在外卸过程中存在的二次扬尘问题,对新型除尘灰拉运车辆进行试验,结合大灰仓的一系列改造,消除卸灰过程中存在的诸多问题,避免卸灰过程中的二次扬尘现象及除尘灰外运过程中对外围环境造成的污染。     

湿法作业在钢渣磁选线的抑尘应用

在钢渣磁选加工过程中,粒度和含水率都会发生变化,钢渣含水率低,易产生扬尘。文章通过对磁选加工线扬尘问题、现场物料及起尘原因的分析,结合现场环境监测数据,制定了经济环保、切实有效的抑尘措施,通过合理设置喷雾头,将钢渣含水率提高至20%左右时,整体抑尘效率可达92%以上。湿法作业方法的系统应用可有效解决钢渣磁选过程中的扬尘问题。     

碎矿常规流程通风除尘系统设计改造

介绍了德兴铜矿大山选矿厂碎矿前3万吨日处理矿石系统通风除尘设计改造,从矿石的破碎、筛分、转卸等产尘点进行密闭、抽风、除尘的设备及设施存在的问题:除尘效率低、排风含尘浓度高、运行耗水量大、除尘器内风道频繁堵塞等问题提出了改进方案,重新设计并付诸实施。     

炼钢厂转炉二次除尘和顶吸除尘系统应用

对福建三安炼钢厂转炉二次除尘系统的改造实践进行了详细的介绍。对旧二次除尘系统改造和增加炉顶吸尘系统后,彻底解决了转炉兑铁、冶炼过程烟尘外溢以及厂房顶部冒烟尘的问题,减少了空气污染,改善了自然环境。     

Essentials of a complete physical examination

The goal of the physical examination is to obtain valid information concerning the health of the patient. The examiner must be able to identify, analyze, and synthesize the accumulated information into a comprehensive assessment. This article outlines the details of the examinations of the individual organ systems that should be evaluated during a podiatric screening physical examination. Some parts of the physical examination have been omitted intentionally. Attention is paid to the recognition of pedal manifestations of systemic disease.     

Analysis of core virion polypeptides from the pathogen causing chicken egg-drop syndrome

This article introduces the podiatric physician interested in pediatrics to the resources available on the Internet. It surveys search engines, gateway sites on the World Wide Web leading to a wealth of pediatric information and services, and features such as electronic mail, news-groups, and Gopher sites. Examples illustrate how such resources can be helpful to the practicing podiatrist.