Acupuncture in Australian general practice: practitioner characteristics

The purpose of this study was to examine the role of diabetes mellitus (DM) in infrainguinal bypass graft outcome. One hundred forty-four patients who underwent 170 infrainguinal bypass grafts from 1990 to 1995 were reviewed retrospectively. Seventy-eight patients (94 bypasses) had DM and were followed for an average of 15.4 months; 13 patients were lost to follow up. The mean age was 68 years; 44 (56.4%) were men. The major indication for intervention was limb salvage for the DM (87/94, 92.6%) and non-DM (56/76, 73.7%) groups. No significant difference was found for perioperative wound complications, hematoma, myocardial infarction, or deep venous thrombosis between the DM and non-DM groups. Early mortalities were three for DM and one for non-DM patients. No significant difference was found between primary patency (p = 0.71), secondary patency (p = 0.32), limb salvage (p = 0.99), and survival (p = 0.72) between DM and non-DM groups. DM patients were more likely to have significant tissue loss (p = 0.009) and a longer hospital stay (p = 0.01). In conclusion, infrainguinal vein bypass grafting can be performed successfully in diabetic patients with comparable patency and limb-salvage rates to those without DM.     

Therapy after skeletal fixation in the hand and wrist

Skeletal fixation can be very beneficial to the recovery of wrist and hand function after a displaced fracture because it allows mobilization of soft tissues before the completion of fracture healing. The benefits of skeletal fixation can be greatly diminished, however, if excessive force causes the fixation to fail before fracture healing has occurred, infection occurs around the implant, or the patient develops reflex sympathetic dystrophy. Those complications, as well as others, are often caused by inappropriate or inadequate hand therapy. This article discusses the techniques needed to avoid many such complications while providing the best possible functional result for every patient.     

Dermatitis artefacta

A case of dermatitis artefacta is reported. The lesions were shown to contain silver and were probably caused by a silver nitrate caustic stick. The patient never admitted to having produced these lesions.