Preliminary Experience with a New Sclerosing Foam in the Treatment of Varicose Veins

BACKGROUND: Recently a new method of using a foam sclerosing agent for the treatment of leg veins has been described. We present a pilot study of a new technique for producing the sclerosing foam (Tessari's method) (SFT) and its use in sclerotherapy of major and minor varicosities. OBJECTIVE: A preliminary multicenter experience of sclerotherapy performed by means of this new kind of sclerosing foam made of purified sodium tetradecylsulfate is described. The authors evaluated the safety and efficacy of different doses and concentrations of the drug as well as different methods of preparing the foam in addition, the results of this technique were evaluated. METHODS: Over a 6-week period the three authors performed sclerotherapy or duplex-guided sclerotherapy using SFT, treating 77 patients. The SFT was formed using a three-way stopcock and two syringes, mixing air with liquid sodium tetradecylsulfate to create a foam. Each author used different concentrations (0.1-3%) and doses (2-8 ml) of SFT according to the size and number of the veins. Alternate methods of preparing the foam were examined as well. Seventy percent of the sclerotherapy sessions were performed on either the long or short saphenous veins, recurrent varices, or collaterals. Thirty percent of the treatments were for reticular varices and telangiectases. RESULTS: At 1-month follow-up, the vast majority of treated larger veins were either obliterated or showed a normal state of cephalad blood flow. Results for minor varicosities were good, but with related complications of hyperpigmentation and small areas of cutaneous necrosis. Two patients experienced transient scotomas and one patient developed segmental phlebitis of a collateral vein. The best foam was obtained by mixing one part liquid sodium tetradecylsulfate and four to five parts air, but the duration of the foam product was also related to several other factors. CONCLUSION: This preliminary pilot study demonstrates that the technique of producing sclerosing foam according to Tessari's method (three-way stopcock device) is very promising, especially for larger veins. No serious complications were reported, and further standardization of the method may improve the results and feasibility of this technique. Further studies are needed to validate this new technique.     

A medical student-staffed outpatient oncology clinic: A 10-year Brazilian experience

BACKGROUND: This is an update of a 10-years student-staffed oncology clinic. METHODS: Students are divided into 4 teams; each sees 1 to 2 outpatients weekly. RESULTS: By April 2006, 95 medical students participated, 89% for 2 or more years; 70% reported activity contributed to ability to read medical papers, and 59% improved their scientific writing. Of 39 students currently involved, 33 (84%) improved clinical skills in taking history, 27 (69%) in physical examination, and 34 (87%) in physician-patient relation. A total of 21 (56%) reported increased knowledge in general internal medicine. Although only 11% of former students pursued a specialty in Medical Oncology, 77% rated this clinic as the best extracurricular activity. CONCLUSIONS: Attendance of outpatient clinic in medical oncology can contribute significantly to the general medical education.     

Rural Women and Osteoporosis: Awareness and Educational Needs

CONTEXT: Little is known about rural women's knowledge about osteoporosis. PURPOSE: To explore what women from high-prevalence rural communities know about osteoporosis and to assess their learning preferences. METHODS: We surveyed 437 women in rural Washington and Oregon. FINDINGS: The response rate was 93% (N = 406). The mean age of respondents was 63 years (range 16-95) and 74% (n = 301) of women were postmenopausal. While 27% over age 40 (n = 111) reported having a fracture as an adult, less than half of this group (42%, n = 47) considered themselves at risk for osteoporosis. Of the 42% (n = 171) who rated their knowledge of osteoporosis good or excellent, only 18% (n = 30) answered calcium and vitamin D questions correctly. About half (53%; n = 214) exercised 3 or more times per week. Reported sources of osteoporosis information included television, magazines, health care providers, and personal contacts. Over half of the women in this study wanted more information about osteoporosis, most wanted it before age 50, and health care providers were a preferred source. Less than half of participants reported having Internet access. CONCLUSIONS: While many participants underestimated their osteoporosis risk, most women wanted to learn more about osteoporosis and health care providers remain a preferred source of information.     

Insights into pathogenesis and treatment of cytokines in cardiomyopathy

Our understanding of the pathophysiology of chronic heart failure is rapidly expanding. recent investigations suggest a role for various proinflammatory and vasoconstrictive cytokines in the development and progression of the disease. In particular, tumor necrosis factor-α, interlukin-6, and endothelin have all been implicated in heart failure desease progression. These cytokines appear to be activated in response to a remodeling, induction of programmed cell death, neurohormonal activation, and hemodynamics, these agents cause a variety of deleterious effects in the setting of ventricular dysfunction. Investigational inhibitors and antagonists of these substances show promise for the future treatment of heart failure.     

Pulmonary nocardiosis

Pulmonary nocardiosis is an uncommon but serious infection that is increasingly found in immunosuppressed persons, especially transplant recipients and persons with AIDS. The Nocardia species are denizens of soil and decaying plants that gain entry to humans through inhalation or inoculation. Pulmonary nocardiosis typically presents as an acute to subacute necrotizing pneumonia, with a variable clinical picture. Metastatic infections of the brain and subcutaneous tissues are common complications. Most clinical laboratories can isolate these microorganisms, but final speciation may be a challenge and antimicrobial susceptibility testing is especially difficult because of the slow rate of growth of Nocardia species. Full identification of species and susceptibility testing is important because of the epidemiologic implications and the difficulties of successfully treating these infections in immunosuppressed patients. Sulfonamides, including trimethoprim-sulfamethoxazole, remain the most reliable antimicrobials. Many alternative agents are active against Nocardia in vitro, but clinical data are limited.     

Combination Lower Lip Prosthesis Retained by an Intraoral Component

Patients who have had a partial or full surgical resection of the maxillary or mandibular lip experience difficulties with articulation of speech, swallowing, and salivary control. This is further complicated by significant alterations in facial esthetics and lowered self‐esteem. This clinical treatment will describe the fabrication of a two‐piece tooth‐retained maxillofacial prosthesis. An intraoral retentive portion and an extraoral section restoring lip anatomy were attached by retentive elements. This prosthesis restored the patient's esthetics, oral function, and self‐esteem.