A leg ulcer as manifestation of metastatic squamous cell vaginal carcinoma

Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg.     

Postnatal development of hypoglossal motoneurons that innervate the hyoglossus and styloglossus muscles in rat

Postnatal development of hyoglossus and styloglossus motoneurons was studied in this investigation of the hypoglossal nucleus. Our findings show separate and distinct locations for hyoglossus and styloglossus motoneurons within the retrusor (dorsal) subdivision of the hypoglossal nucleus for all age groups. Hyoglossus and styloglossus motoneuron cross-sectional area reached their adult size at different times (by weeks 2 and 3, respectively). Cell roundness, as measured by form factor (measure of cell perimeter relative to its area), decreased with advancing postnatal age for both populations of motoneurons. Differences in the direction of the dendritic projection between hyoglossus and styloglossus motoneurons were found. Hyoglossus and styloglossus motoneuron development was compared to genioglossus motoneuron postnatal development.     

Managing stakeholder loyalty.

The authors question the utility of relying on the conventional wisdom in healthcare that satisfaction is the proper measure of strategic health. They offer four reasons why "stakeholder value" is the more appropriate measure. They present a case of a large midwestern HMO that has evolved to a stakeholder value approach. They demonstrate the linkages among the different components of the Stakeholder Value Information System, how stakeholder assessments of value drive loyalty and other key measures, and how that system can be used to inform strategic and operational decision making.     

Untersuchung zur Kategorisierung des mandibulären Wachstumspotentials von Petrovic,Lavergne und Stutzmann

Zusammenassung In der vorliegenden Studie sollte untersucht werden, ob die vonPetrovic, Lavergne undStutzmann vorgeschlagene Kategorisierung des mandibulären Wachstumspotentials für die Behandlung mit dem Funktionsregler Geltung hat. Dazu wurden die Fernröntgenaufnahmen von 140 Patienten der Angle-Klasse II nach zirka zweijähriger Behandlung mit Funktionsreglern analysiert. Im Vergleich zu 133 unbehandelten Kindern mit Angle-Klasse II trat in fast allen Rotationsgruppen eine signifikant größere Zunahme der Unterkiefergesamtlänge ein. Zwischen der Kategorie 2 mit niedrigem Wachstumpotential und Kategorie 5 mit hohem Wachstumspotential wurden keine signifikant unterschiedlichen Zunahmen der Unterkieferlänge festgestellt.

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Summary The results of the study show whether the classification of mandibular growth potential, as proposed by Petrovic, Lavergne and Stutzmann has any influence on the treatment with a function regulator. X-rays of 140 class II patients were analysed after a treatment time of approximately 2 years. In comparison with 133 class II children without any treatment, a significant increase of the overall mandibular length was observed in almost all children treated. There was no significant difference in the increase of mandibular length between category 2 (low growth potential) and category 5 (high growth potential).

     

A national random survey of bone mineral density reporting in the United States.

The rapidly evolving technology of bone mineral density (BMD) testing has revolutionized the clinical care of osteoporosis; however, at present, there are no guidelines for BMD reporting. A survey was mailed to a random sample of bone densitometry centers in the United States registered in the National Osteoporosis Foundation database in order to evaluate the practice of BMD reporting in the United States. Of the 1200 questionnaires mailed, 22.5% were completed and returned. Spine and hip BMD were routinely measured at 71% of the centers and were expressed as T-scores by 90% of centers. The World Health Organization working group definition of osteoporosis was included in the report by 64% of the survey responders and was used as the sole criterion to make treatment recommendations by 34%. Fracture risk was reported by 70% of the centers and only the minority (<15%) applied appropriate age and gender restrictions. There were geographic and specialty variations in the practices of bone density reporting. Despite the established value of clinical densitometry in the care of patients at risk for osteoporosis, our survey revealed that clinical information, including fracture risk, was missing from many reports. A re-examination of the practice of clinical densitometry reporting is warranted.