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1.
Helen Mashek MD Barbara Licznerski MD Stephanie Pincus MD 《International journal of dermatology》1997,36(4):276-278
A 33-year-old African woman was evaluated for tender nodules on her feet. Accompanied by her four children, she had recently immigrated from Somalia. Before her immigration, she resided in a Kenyan refugee camp for approximately 1 year, where she walked barefoot in sand and dirt. The patient stated that she and her four children, as well as many people living in the same compound, had similar, tender lesions on their feet. Her children were "treated" by their grandmother, who removed the contents of their lesions with a safety pin.
On physical examination the patient had numerous tender, isolated, and clustered hyperkeratotic, crusted papules, measuring 4–6 mm, on the plantar and periungual surfaces. Several lesions were ulcerated (Figs 1 and 2). The hyperkeratotic masses were debrided with a surgical blade. An intact, white, coiled structure was curetted from each papule, leaving numerous empty crater-like lesions (Fig. 3), which were identified on histologic sections as Tunga penetrans. Microscopic examination of unstained specimens showed branching, thin, translucent tubular structures with numerous eggs. Ring-shaped cross-sections of the organism's respiratory and digestive tracts were seen on hematoxylin and eosin stain (Fig. 4).
The patient received a 10-day course of dicloxacillin and topical bacitracin ointment. All lesions were healed within 1 week of therapy. 相似文献
On physical examination the patient had numerous tender, isolated, and clustered hyperkeratotic, crusted papules, measuring 4–6 mm, on the plantar and periungual surfaces. Several lesions were ulcerated (Figs 1 and 2). The hyperkeratotic masses were debrided with a surgical blade. An intact, white, coiled structure was curetted from each papule, leaving numerous empty crater-like lesions (Fig. 3), which were identified on histologic sections as Tunga penetrans. Microscopic examination of unstained specimens showed branching, thin, translucent tubular structures with numerous eggs. Ring-shaped cross-sections of the organism's respiratory and digestive tracts were seen on hematoxylin and eosin stain (Fig. 4).
The patient received a 10-day course of dicloxacillin and topical bacitracin ointment. All lesions were healed within 1 week of therapy. 相似文献
2.
OBJECTIVE: The authors examined whether physicians' use of computerized decision aids affects patient satisfaction and/or blame for medical outcomes. METHOD: Experiment 1: Fifty-nine undergraduates read about a doctor who made either a correct or incorrect diagnosis and either used a decision aid or did not. All rated the quality of the doctor's decision and the likelihood of recommending the doctor. Those receiving a negative outcome also rated negligence and likelihood of suing. Experiment 2: One hundred sixty-six medical students and 154 undergraduates read negative-outcome scenarios in which a doctor either agreed with the aid, heeded the aid against his own opinion, defied the aid in favor of his own opinion, or did not use a decision aid. Subjects rated doctor fault and competence and the appropriateness of using decision aids in medicine. Medical students made judgments for themselves and for a layperson. RESULTS: Experiment 1: Using a decision aid caused a positive outcome to be rated less positively and a negative outcome to be rated less negatively. Experiment 2: Agreeing with or heeding the aid was associated with reduced fault, whereas defying the aid was associated with roughly the same fault as not using one at all. Medical students were less harsh than undergraduates but accurately predicted undergraduate's responses. CONCLUSION: Agreeing with or heeding a decision aid, but not defying it, may reduce liability after an error. However, using an aid may reduce favorability after a positive outcome. 相似文献
3.
4.
Incidence of BK with Tacrolimus Versus Cyclosporine and Impact of Preemptive Immunosuppression Reduction 总被引:8,自引:0,他引:8
Daniel C. Brennan Irfan Agha Daniel L. Bohl Mark A. Schnitzler Karen L. Hardinger Mark Lockwood Stephanie Torrence Rebecca Schuessler Tiffany Roby Monique Gaudreault-Keener Gregory A. Storch 《American journal of transplantation》2005,5(3):582-594
Our purposes were to determine the incidence of BK viruria, viremia or nephropathy with tacrolimus (FK506) versus cyclosporine (CyA) and whether intensive monitoring and discontinuation of mycophenolate (MMF) or azathioprine (AZA), upon detection of BK viremia, could prevent BK nephropathy. We randomized 200 adult renal transplant recipients to FK506 (n = 134) or CyA (n = 66). Urine and blood were collected weekly for 16 weeks and at months 5, 6, 9 and 12 and analyzed for BK by polymerase chain reaction (PCR). By 1 year, 70 patients (35%) developed viruria and 23 (11.5%) viremia; neither were affected independently by FK506, CyA, MMF or AZA. Viruria was highest with FK506-MMF (46%) and lowest with CyA-MMF (13%), p = 0.005. Viruria >/= 9.5 log(10) copies/mL was associated with a 3-fold increased risk of viremia and a 13-fold increased risk of sustained viremia. After reduction of immunosuppression, viremia resolved in 95%, without increased acute rejection, allograft dysfunction or graft loss. No BK nephropathy was observed. Choice of calcineurin inhibitor or adjuvant immunosuppression, independently, did not affect BK viruria or viremia. Viruria was highest with FK506-MMF and lowest with CyA-MMF. Monitoring and preemptive withdrawal of immunosuppression were associated with resolution of viremia and absence of BK nephropathy without acute rejection or graft loss. 相似文献
5.
Stephanie Atkinson 《Canadian Medical Association journal》2004,170(8):1208-1209
6.
7.
Jutta Liebau Stephanie Heidrich Alfred Berger Mayer Tenenhaus Hans-Oliver Rennekampff 《European journal of plastic surgery》2007,29(5):235-242
Re-epithelialization of cutaneous wounds is a coordinated process of proliferation and migration of keratinocytes at the wound
edge. The study objective was to identify the differences in epidermal morphology, keratinocyte proliferation and matrix molecules
(laminin 1, laminin 5, type IV collagen) and their specific integrin (α3, α6) expression in biopsies of meshed split thickness
grafted and chronic wounds. The mean mitotic index of keratinocytes (ratio of cell cycle associated antigen Ki-67 expressing
keratinocytes to basal keratinocytes) was highest in chronic wounds (38.7%) compared to acute wounds (22.25%, range 5.7% to
54%). The mean thickness of the hyper-proliferative epithelium at the wound edge of chronic wounds was 0.69 mm compared to
0.15 mm at the wound margin of split thickness grafted wounds. Both chronic wounds and skin grafted wounds exhibited strong
laminin 5 immunoreactivity at the basal side of the epithelium, which extended under the most forward keratinocytes. Laminin
1 and type IV collagen immunoreactivity did not extend to the wound margin in either skin grafted or chronic wounds. In both
transplanted skin and chronic wounds, the integrin sub-units α3 and α6 exhibited a strong pericellular immunoreactivity on
the leading keratinocytes of the wound margin. Our data demonstrates that the proliferation of keratinocytes and the expression
of associated integrins are not impaired in chronic wounds.
Presented at the 33rd Congress of the Association of German Plastic Surgeons, Germany, 18–21 September, 2002. 相似文献
8.
9.
Peter M. Ravdin Stephanie Green James H. Doroshow Silvana Martino 《Investigational new drugs》1994,12(4):333-336
Summary Thirty-two eligible patients with advanced metastatic breast cancer who had received no more than 1 prior chemotherapy regimen for metastatic disease (16 had received prior doxorubicin) were treated with piroxantrone at a dose of 120 mg/m2 intravenously every 21 days. In the twenty-seven patients evaluable for response, two partial responses were seen. Toxicities observed were primarily hematologic with grade 3 or greater granulocytopenia occurring in 34% of the patients. One patient developed symptomatic congestive heart failure at a total cumulative dose of 960 mg/m2. We conclude that piroxantrone given at this dose and schedule has minimal activity in patients with metastatic breast cancer. 相似文献
10.
A Thalamic Contribution to Arousal-induced, Non-photic Entrainment of the Circadian Clock of the Syrian Hamster 总被引:3,自引:0,他引:3
Elizabeth S. Maywood Emma Smith Stephanie J. Hall Michael H. Hastings 《The European journal of neuroscience》1997,9(8):1739-1747
It is well established that the circadian clock of the suprachiasmatic nuclei (SCN) is entrained by light. More recently, the potent effects of arousing, non-photic cues on the clock have been recognized. The neural mediators of non-photic entrainment are yet to be identified. To examine the contribution of the thalamic intergeniculate leaflet (IGL) and its NPY-immunopositive projection, the geniculo-hypothalamic tract to non-photic entrainment by arousal, male Syrian hamsters received lesions of the IGL (IGLX) which ablated NPY-immunoreactivity in the SCN. Their circadian responses to both photic and non-photic cues were then tested. Lesions resulted in a delay in the timing of activity onset following lights out, but had no effect on the behavioural or cellular circadian responses to phase-advancing light pulses presented at circadian time (CT) CT19 (where CT12 represents the time of activity onset). Injection with a benzodiazepine (chlordiazepoxide, 100 mg/kg) at CT6 suppressed wheel-running, increased general locomotion of intact controls and induced large phase advances of the circadian rhythm of wheel-running. Chlordiazepoxide also inhibited wheel-running in lesioned animals, but there was no significant increase in general locomotion and the lesioned animals did not phase advance. Serial arousal by injection of saline at intervals of 23.5 h for 6 days entrained the circadian rhythm of wheel-running of intact hamsters and was associated with an increase in general locomotor activity. Entrainment by serial arousal was abolished by IGLX. However, the lesioned animals did show a clear behavioural response to every presentation of the non-photic cue. These results show that the IGL is a necessary component of the neural pathways mediating both arousal- and benzodiazepine-induced non-photic entrainment. 相似文献