Experimental and clinical validation of auto- and allodermoplasty using transverse dermal micrografts in deep burns

A new method of autoallodermoplasty is proposed which is as follows: a patient's skin band is cut out 40 times less than the total area of the wound surface. The wound in the donor area is sutured tightly. The skin flap is dissected to thin transverse rectangular pieces with a special microdermatome or with a razor and then they are laid with their lateral side onto the wound and covered with the allo-skin. Experimental and clinical observations have shown that at remote terms both the anatomical and functional restitution of the integument occurred. The method is indicated for huge dermal defects of the "functionally passive" areas in patients with restricted, not big resources of the donor sites, especially in patients with high operative risk.     

Molecular and genetic features of fragile X syndrome

This study explored the claim that superior disembedding performance in autism reflects "less capture by meaning" and/or reduced "central coherence" [Shah & Frith, Journal of Child Psychology & Psychiatry, 24, 613-620 (1983); Shah & Frith, Journal of Child Psychology & Psychiatry, 34, 1351-1364 (1993)]. Meaningless as well as meaningful disembedding contexts were used, and memory for contextual information was examined. Neither qualitative (search strategy) nor quantitative (RT or accuracy) data indicated that high-functioning individuals with autism/PDD were superior to younger, developmentally matched controls. For both groups, disembedding was slowest from meaningful contexts, which generally were remembered best. No evidence was provided for "less capture by meaning" or reduced "central coherence" in autism/PDD, raising the possibility that earlier findings reflect a developmental, rather than a stable autism-specific, phenomenon.     

Successful electroconvulsive therapy of Cotard syndrome with bitemporal hypoperfusion

A case study is presented to illustrate a rare condition described by Cotard as "délire de négation". The central symptom is a nihilistic delusion with denial of one's own existence of oneself and that of the external world. In the present case, the syndrome became manifest as an escalation of a recurrent depressive disorder late in life. After initial resistance to therapy, the syndrome was successfully treated with electroconvulsive therapy. For the first time, we report the regional cerebral blood flow measured by 99mTc-HMPAO-SPECT before and after therapy. Before treatment, significant bitemporal hypoperfusion relative to the cerebellum was found, which was no longer demonstrable on remission.     

Measurements of indoor and outdoor nitrogen dioxide concentrations using a diffusive sampler

The Willems badge, a short-term diffusion sampler, was used to measure nitrogen dioxide concentrations inside and outside the homes of participants in the European study "PEACE' (Pollution Effects on Asthmatic Children in Europe). The main aim of the study was to determine levels of nitrogen dioxide concentrations both outside and inside children's homes, and to estimate the indoor/outdoor ratios for nitrogen dioxide in an urban area, in comparison with a less urbanized control area. We conducted measurements in 23 homes in Ume?, a city of about 100,000 inhabitants in the northern part of Sweden, in addition to 20 homes in a less urbanized control area situated about 20 km from Ume?. Measurements were made on two different occasions in each home during the period January-March, 1994. The houses were not equipped with any gas appliances. The mean outdoor 24-h concentration in Ume? was 28 micrograms m-3 and the mean indoor concentration was 11 micrograms m-3. The mean indoor: outdoor ratio was 0.44 (s = 0.23). The highest outdoor value, measured in the city centre of Ume?, was 54 micrograms m-3. In the control area the mean ambient 24-h concentration was 12 micrograms m-3, approximately half as high as in the urban area, and the mean indoor concentration was 6 micrograms m-3. The mean indoor: outdoor ratio was 0.67 (s = 0.55). The correlation coefficient between indoor and outdoor concentrations was higher in the control area, r = 0.79 (p < 0.001), in comparison with the urban area, r = 0.43 (p < 0.01). It is concluded that the outdoor as well as the indoor concentrations of nitrogen dioxide were approximately twice as high in Ume? as in the control area. This could be explained by heavier traffic density in Ume?. The mean 24-h concentration outside homes in Ume? was, however, below the 24-h national standard level of 75 micrograms m-3. The higher correlation between indoor and outdoor concentrations, combined with higher indoor: outdoor ratio, in the control area is interpreted as a sign of a lower level of penetration of outdoor air into the houses in the urban area. This was not explained by differences in types of buildings between the two areas, but possibly by differences in air-exchange rates and in habits of ventilating rooms with open windows.     

Quality assurance in coloscopy in private practice and the hospital. The Gastroenterology Quality Circle (GEQC) Munich

OBJECTIVE: As quality control in medicine is part of a doctor's professional duty, the "Munich Quality Circle" conducted a prospective feasibility study in which ten, previously defined, quality indicators were to be assessed. PATIENTS AND METHODS: Six specialised private practice groups and three specialised hospitals centers took part. Data on 2928 consecutive patients were collected by questionnaire and ten quality indicators assessed: concordance with the indication list; intestinal cleansing; premedication; duration and completeness of the study; sensation of pain; use of radiology; complications; diagnosis; and therapeutic intervention. RESULTS: Concordance with the indication list was present in 97.8% (range 93-100), premedication was given to 94.6% (77-100), midazolam to 77%. The proportion of patients who recorded no or only moderate pain correlated with the dose but not with the duration of advancing the coloscope. Mean time of advancing the instrument to the caecum was 8.0 min, the duration directly depending on the experience of the examiner. A mean time of less than 10 minutes was achieved only after more than 1200 examinations. The more a centre used fluoroscopic control the shorter the time of coloscopy. The examination was completed in 97.6% (92-99). There was no correlation between experience (assuming supervision) and dose of midazolam or frequency of fluoroscopy. CONCLUSIONS: Nowadays total coloscopy is a primary diagnostic method, but it needs an intensive learning phase. In clinical centers consequent supervision of less experienced examiners achieved comparable results to those with experience. Informative quality indicators for coloscopy can be documented with little cost.     

Properties of whole saliva and dental plaque in relation to 40-month consumption of chewing gums containing xylitol, sorbitol of sucrose

The concern with nursing research in the future work of nurse graduates. Expectations from the viewpoint of the nurse researcher. Keeping in mind the concerns which occupy nurse researchers now and in the future, expectations are raised of the graduates of degree programmes in nursing science which are now also being established in the Federal Republic of Germany. This takes into account the structurally determined areas of self determined action in new fields of professional practice. Nurse graduates will be seen as "change agents" in their future areas of work and will have three essential aspects of involvement with nursing research: 1. they themselves will conduct research 2. they will receive, put into practice and transmit results of nursing research 3. they will initiate and commission nursing research projects. According to the broad topics of nursing research, requirements for nurses to act as professionals in their new working fields are formulated referring to the given structural conditions in Germany.     

Importance of participation rate in sampling of data in population based studies, with special reference to bone mass in Sweden

OBJECTIVE: To study the effects of participation rate in sampling on "normative" bone mass data. DESIGN: This was a comparison between two randomly selected samples from the same population. The participation rates in the two samples were 61.9% and 83.6%. Measurements were made of bone mass at different skeletal sites and of muscle strength, as well as an assessment of physical activity. SETTING: Malm?, Sweden. SUBJECTS: There were 230 subjects (117 men, 113 women), aged 21 to 42 years. RESULTS: Many subjects participated in both studies (163). Those who took part only in the study with the higher participation rate (67) almost invariably had higher values for bone mass density at the sites measured (up to 7.6% for men) than participants in the study with the lower participation rate. No differences in muscle strength were recorded. CONCLUSION: A high degree of compliance is important to achieve a reliable result in determining normal values in population based studies.     

Primary metastatic carcinoma of the prostate in younger men: a plea to think over usual therapeutic strategies

METHOD: The time from first diagnosis of primary multiple metastatic prostate carcinoma until progression and until death in patients less than 60 years old under two different therapeutic regimens was evaluated. RESULTS: In the group with pure androgen deprivation (n = 21), the mean time until progression was 11.3 (6-55) months, the mean survival time being 21.4 (11-75) months. In the group with androgen deprivation plus cytostatic therapy (n = 10), progression was noted after 26.7 (15-77) months with a medium survival time of 26.2 (16-82) months. CONCLUSION: The data argue in favor of changing the usual treatment strategy to combination therapy in "young' patients with primary metastatic prostatic cancer.     

Atopic dermatitis and food allergy in infancy and childhood

Food allergies are causal factors for atopic dermatitis (AD) in 50% in infancy, in 20 to 30% in childhood, and only in 10 to 15% after puberty and in adulthood. Cow's milk, egg, fish, wheat, soy, nuts and citrus-fruits are the most proven allergens. Pseudoallergens, especially food-additiva, have to be regarded too. For the proof of the clinical relevance that food allergy is causing AD a positive result of elimination and provocation has to be required. When by these diagnostic procedure a special food is found as causing the AD it has to be eliminated in the diet of this patient. In severe cases of AD semi-elementary respectively few foods diets may be necessary. However in most cases of AD the "diet of choice" is an age related normal nutrition. To delay respectively to avoid the manifestation of atopy special recommendations for the nutrition of high risk newborns and infants (especially long breast feeding, late solid feeding) should be considered.     

Infrared temperature measurement in the ear canal with the DIATEK 9000 Instatemp and the DIATEK 9000 Thermoguide. Comparison with methods of temperature measurement in other body parts

Temperature of the tympanic membrane is recommended as a "gold standard" of core-temperature recording. However, use of temperature probes in the auditory canal may lead to damage of tympanic membrane. Temperature measurement in the auditory canal with infrared thermometry does not pose this risk. Furthermore it is easy to perform and not very time-consuming. For this reason infrared thermometry of the auditory canal is becoming increasingly popular in clinical practice. We evaluated two infrared thermometers-the Diatek 9000 Thermoguide and the Diatek 9000 Instatemp-regarding factors influencing agreement with conventional tympanic temperature measurement and other core-temperature recording sites. In addition, we systematically evaluated user dependent factors that influence the agreement with the tympanic temperature. MATERIALS AND METHODS: In 20 volunteers we evaluated the influence of three factors: duration of the devices in the auditory canal before taking temperature (0 or 5 s), interval between two following recordings (30, 60, 90, 120, 180 s) and positioning of the grip relative to the auditory-canal axis (0, 60, 180 and 270 degrees). Agreement with tympanic contact probes (Mon-a-therm tympanic) in the contralateral ear was investigated in 100 postoperative patients. Comparative readings with rectal (YSI series 400) and esophageal (Mon-a-therm esophageal stethoscope with temperature sensor) probes were done in 100 patients in the ICU. The method of Bland and Altman was taken for comparison. RESULTS: Shortening of the interval between two consecutive readings led to increasing differences between the two measurements with the second reading decreasing. A similar effect was seen when positioning the infrared thermometers in the auditory canal before taking temperatures: after 5 s the recorded temperatures were significantly lower than temperature recordings taken immediately. Rotation of the devices out of the telephone handle position led to increasing lack of agreement between infrared thermometry and contact probes. Mean differences between infrared thermometry (Instatemp and Thermoguide, CAL-Mode) and tympanic probes were -0.41 +/- 0.67 degree C (2 SD) and -0.43 +/- 0.70 degree C, respectively. Mean differences between the Thermoquide (Rectal-Mode) and rectal probe were -0.19 +/- 0.72 degree C, and between the Thermoguide (Core Mode) and esophageal probe -0.13 +/- 0.74 degree C. DISCUSSION: Although easy to use, infrared thermometry requires careful handling. To obtain optimal recordings, the time between two consecutive readings should not be less than two min. Recordings should be taken immediately after positioning the devices in the auditory canal. Best results are obtained in the 60 degrees position with the grip of the devices following the ramus mandibulae (telephone handle position). The lower readings of infrared thermometry compared with tympanic contact probes indicate that the readings obtained represent the temperature of the auditory canal rather than of the tympanic membrane itself. To compensate for underestimation of core temperature by infrared thermometry, the results obtained are corrected and transferred into core-equivalent temperatures. This data correction reduces mean differences between infrared recordings and traditional core-temperature monitoring, but leaves limits of agreement between the two methods uninfluenced.