Lisfranc's fracture-dislocation. A literature review and case presentations of tarsometatarsal joint injuries

Lisfranc's fracture-dislocations are relatively infrequent injuries that may result in major debilitation. A review of the literature is presented with focus on the proper evaluation, diagnosis, and management of these injuries. Three cases are presented that illustrate the more common mechanisms of injury.     

Prevention of nonmelanoma skin cancer. Standard and investigative approaches

Today, in many fields of medicine, the focus is on prevention. This discussion highlights the salient features of sunscreens, protective clothing, and education, as they relate to the hazards and potential sequelae of sun exposure and tanning parlors. It also includes information on the status of clinical and laboratory investigation in the development of agents to prevent skin cancer in high-risk individuals.     

Health status and health care costs for publicly funded patients with schizophrenia started on clozapine

OBJECTIVE: The study examined the effect of clozapine treatment on the health care costs and health status of people with schizophrenia who are supported by public funds. METHODS: Thirty-three patients with schizophrenia hospitalized in a state facility were interviewed within one week of starting clozapine and six months later. Health status was assessed with four clinical rating scales measuring severity of psychopathology, negative symptoms, depression, and quality of life. Cost and health care utilization data were collected for the six months before and after initiation of clozapine. RESULTS: Only 52 percent of the subjects stayed on clozapine for six months. Subjects who continued on clozapine were more likely to be discharged within six months than those who did not continue. Six months after clozapine was started, health care costs showed a sayings of $11,464 per person, even after adjustment for pretreatment costs, and health status was improved. CONCLUSIONS: For subjects who continued on clozapine for six months, clozapine treatment was associated with reduced days of psychiatric hospital care, reduced overall costs despite increased outpatient treatment and residential costs, and improved health status.     

Epidemiological observations on sarcoids in a population of donkeys (Equus asinus)

An epidemiological study of equine sarcoid in a population of 4126 donkeys showed that the peak incidence of the disease was 15.2 cases per 100 animal-years and occurred in animals in their fourth year of life. The crude incidence of the disease was 0.6 cases per 100 animal-years. The disease occurred most frequently in younger, male animals during their first five years in the population. The lesions were observed most commonly in the paragenital region. Pre-entry quarantine procedures did not appear to play a significant role in the spread of the disease but there was an indication that close in-contact animals were more likely to have sarcoids than animals in the general population. This suggested that a transmissible agent might have been involved in the aetiopathogenesis or that the animals had encountered some event that had predisposed them to the disease.     

Primary sclerosing cholangitis with itching treated during pregnancy with ursodeoxycholic acid

A 23-year old woman with primary sclerosing cholangitis was being treated with ursodeoxycholic acid (URSO). When pregnancy was diagnosed, she was already through the first trimester. The treatment was discontinued, but her symptoms including severe pruritus recurred immediately, and the biochemical markers of bile duct obstruction worsened. It was necessary to start URSO-treatment again, which relieved her symptoms and improved the biochemistry. The remaining part of the pregnancy was uncomplicated, there were no malformations and so far, the baby is doing fine. URSO may be a possible treatment for severe intrahepatic cholestasis and pruritus during pregnancy.