Intravenous cidofovir treatment for recalcitrant warts in the setting of a patient with myelodysplastic syndrome

Cidofovir is an acyclic nucleoside phosphonate with broad-spectrum activity against DNA viruses, including human papilloma virus (HPV). However, data on the efficacy of cidofovir in an immunosuppressive setting remain contradictory. We report for the first time on the promotion of the healing of recalcitrant warts in a patient with myelodysplastic syndrome with intravenous cidofovir treatment.     

Intraoperative ultrasound imaging of the entire brain through unilateral exploratory burr holes after severe head injury: technical note

A portable ultrasound unit with a 3.5-MHz probe allows accurate imaging of both cerebral hemispheres and partial imaging of the posterior fossa through unilateral exploratory burr holes or a craniotomy. In patients with clinical signs of transtentorial herniation after severe head injury, this unilateral technique can detect extraaxial and intraparenchymal mass lesions more accurately than is possible with bilateral exploratory burr holes.     

Bottlefeeding with a Breast-like Nipple

Forty normal one-month-old infants were randomly assigned to a breast-like nipple (Healthflow) bottlefeeding or a standard nipple (Evenflo) bottlefeeding group for one 20-minute feeding by the infants' mothers. The data suggested that the mothers' bottlefeeding behaviors did not differ, but the infants who fed on the breast-like nipples spent less time asleep, more time awake and active and less time fussing and crying. In addition, the vagal tone of that group decreased more during bottlefeeding and increased more after the feeding, suggesting that the breast-like nipple bottlefeedings were more similar to breastfeedings (vagal tone being lower during breastfeeding and higher after breastfeeding versus bottlefeeding). Because many women who breastfeed return to work, bottlefeeding that more closely approximate breastfeedings may ease this transition and may provide more effective supplemental feedings for the breastfed infants.     

Some of the factors to be considered in the prescription and timing of bitewing radiography in the diagnosis and management of dental caries.

This article describes some of the factors to be considered by the practitioner when prescribing bitewing radiographs in the diagnosis and management of dental caries and draws on the literature of a number of disciplines including restorative dentistry, cariology, epidemiology and oral radiology. It seems appropriate to re-assess current practice in the light of information on changes in the disease of dental caries, its behaviour and the way this behaviour may vary in high and low caries risk groups. The diagnostic potential of the bitewing examination appears, at present, to be unrivalled, but other diagnostic methods, such as fibreoptic transillumination and tooth separation, must also be considered. Some methods to minimize radiation doses and increase diagnostic yield are discussed. Current knowledge of prescribing patterns is reviewed and areas of ignorance are mentioned as findings from future research in these areas may influence decisions about when to use and re-use bitewing radiographs.     

Prognosticators of outcome after major head injury in the elderly.

In 195 elderly head-injured patients, Glasgow Coma Scale (GCS) scores (admission and 72 hours) and intracranial pressure (ICP) 0-12 days after injury were compared to 6 month Glasgow Outcome Scores. All patients remaining comatose at least 72 hours after injury died within 6 months. The mortality rate among patients with ICP greater than 20 mm Hg was higher both at 72 hours and at 6 months after injury. The 6 month mortality rate was 75% overall and 90% among patients with elevated ICP. This increased mortality in elderly patients with initially elevated ICP indicates that nurses and other health professionals should consider ICP as well as level of consciousness when counseling patients and families regarding the likely outcome after major head injuries.     

High energy phosphate metabolism in experimental permanent focal cerebral ischemia: an in vivo 31P magnetic resonance spectroscopy study

Relative levels of phosphate metabolites in the brain were examined in vivo by 31P magnetic resonance spectroscopy (MRS) in 50 Sprague-Dawley rats before, during, and after induction of focal permanent cerebral ischemia. After acquisition of baseline spectra, rats were subjected to injury within the core of the MR spectrometer, and 31P spectra were collected for 60 min after injury: in 7 rats, permanent, acute focal cerebral ischemia was induced (ischemia group); in 6 rats, mild hypoxia (FiO2 14%) was induced at the time of the ischemic insult and was maintained for 20 min (ischemia-hypoxia group); in 6 rats, mild hypoxia (FiO2 14%) only was induced for 20 min (hypoxia group). Control studies were performed in 25 rats. Cerebral intracellular pH, calculated from the chemical shift of inorganic phosphate (Pi), decreased immediately after injury in the ischemia and ischemia-hypoxia groups. The first 31P spectrum obtained after injury was characterized by an increase in Pi and a decrease in phosphocreatine (PCr) in the ischemia and ischemia-hypoxia groups; these changes in spectra were significantly greater in the ischemia-hypoxia group. No significant changes in adenosine triphosphate (ATP) were found in either group. Within 60 min of occlusion, 31P spectra returned toward baseline spectra in both ischemia-hypoxia and ischemia groups. No significant changes were seen in spectra of rats subjected to hypoxia alone. These results confirm that 31P MRS is a sensitive measure of early changes of high energy metabolites in focal cerebral ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Late side-effects with cosmetic relevance following soft X-ray therapy of cutaneous neoplasias

Background Cosmetic changes are to be expected after radiotherapy for skin tumours. Objectives This study aimed to answer the questions: How frequent are cosmetic changes after soft X‐ray therapy? Do treatment parameters, tumour thickness, localization and size of the irradiated field have a major influence? Were patients irritated by the visual appearance of the irradiated field? Methods In total, 2474 examinations of 1149 irradiated fields were performed. Results Hypopigmentation was found in 64.7% of examinations more than 90 days after therapy, teleangiectases in 43.1%, erythema in 24.8%, and hyperpigmentation in 16.8%. The frequency of hypopigmentation, teleangiectases and hyperpigmentation increased with time from X‐ray exposure; more than 4 years after therapy hypopigmentation was diagnosed in 91.8% and teleangiectases in 82.2% of examinations. Total dose, the time–dose–fractionation factor (TDF), field size and dose per fraction were significantly related to the frequency of cosmetic changes. Incidence rates of cosmetic changes differed by less than 15% if different treatment conditions were compared: thicker vs. thinner tumours, larger vs. smaller fields, higher vs. lower total doses, doses per fraction, and TDF. Frequencies of hypopigmentation, teleangiectases, erythema and hyperpigmentation differed by more than 15% between some localizations on the head. Women reported irritation by the visual appearance of the irradiated field in 12.6% of 1116 interviews, and men in 4.4% of 1284 interviews. Conclusions Cosmetic changes after soft X‐ray therapy are relatively frequent. Treatment parameters, tumour thickness and field size have only a minor influence. Few patients, but more women than men, were irritated by the visual appearance of the irradiated field.