Reconstruction of Nonhelical Auricular Defects with Local Flaps

BACKGROUND The integrity of each of the components of the auricle is important for its overall aesthetic appearance. Cartilage-exposing nonhelical defects that are too large to be closed primarily without distorting the auricle may be reconstructed with local flaps.
OBJECTIVE The objective was to present our experience with the reconstruction of nonhelical medium-sized defects using a variety of simple, one-stage local flaps.
PATIENTS AND METHODS Eighteen patients who underwent reconstruction of nonhelical auricular defects with local flaps at our center from 2003 to 2006. Defect size ranged from about 10 to 20 mm. Various methods were used for reconstruction as follows: conchal defect ( n =11)—pull-through postauricular flap or cutaneous rotation flap from the concha itself; triangular fossa defect ( n =3)—transposition-rotation flap from the concha or cutaneous periauricular pull-through flap via the root of the helix; antihelical defect ( n =2)— V-Y advancement flap from the skin of the antihelix; and tragus defect ( n =2)—periauricular cutaneous flap.
RESULTS All flaps survived. Transient congestion was noted in four patients. The aesthetic results were good, with no auricular deformation.
CONCLUSION It is important that reconstructive surgeons be familiar with a variety of basic flaps for reconstruction of nonhelical defects. An algorithm for nonhelical flap reconstruction is suggested.     

Cost implications of the delivery of pharmaceutical care services through Australian community pharmacies

Objective — To conduct a cost analysis of the Community Pharmacy Model Practices project in South Australia. Method — As part of a prospective participatory action research programme, the cost analysis identified the main items of fixed and variable costs and of potential cost savings, and expressed them in a framework to aid decision-making. Setting — Ten community pharmacy practices in primary care: five provided generalist medication management, two diabetes care, two asthma care, and one wound management. Services were provided to 411 pharmacy patients (median age 75; 70 per cent female) in the community, resident in a range of nursing home and hostel accommodation, or patients in hospital. There was a maximum of 11 months' observation. Key findings — All the five medication management pharmacies, one of the asthma management pharmacies, and the wound management pharmacy, but neither of the diabetes management pharmacies, were able to generate potential resource savings greater than their total variable costs, so that net resource savings were available to make a contribution to absorbing fixed costs. Conclusions — The provision of medication management services by community pharmacies working to a well-defined, systematic process of patient care within a primary care setting can be expected to reduce overall direct costs to the health system. Similar findings are likely with wound management in pharmacy care, but the results are less certain for asthma management and diabetes management. These results, when considered in the light of possible gains in survival and quality of life, are of significant interest to policymakers concerned with controlling health system costs.     

经皮股动脉穿刺冠状动脉介入诊疗术后人工压迫止血早期下地活动的临床观察

目的:观察经皮股动脉穿刺冠状动脉介入诊疗术后患者早期下地活动的可行性和安全性。方法:130例行冠状动脉介入诊断和治疗的患者在拔除6F动脉鞘管6h后下地活动,观察其穿刺点并发症的发生。结果:130例141个穿刺部位中发生小血肿8处,皮下淤血8处,小渗血3处,发生腹膜后血肿1处,随访1~3d,无严重出血并发症。结论:经皮股动脉穿刺冠状动脉介入诊疗术后6h下地活动是可行和安全的,可以减少患者的不适和降低患者住院费用。     

Treatment of Angiokeratoma of Fordyce with Pulsed Dye Laser

BACKGROUND: Angiokeratomas of Fordyce are typically asymptomatic vascular lesions characterized by blue-to-red papules with a scale surface, most often located on the scrotum. Although considered benign, the lesions may bleed, either spontaneously or secondary to rupture, leading to patient anxiety and social embarrassment. OBJECTIVE: The objective was to determine the safety and effectiveness of 585-nm pulsed dye laser for the treatment of angiokeratomas of Fordyce. METHODS: Twelve patients with Fitzpatrick skin type II to IV were treated for angiokeratomas of Fordyce with pulsed dye laser (5.5-8.0 J/cm(2)) in two to six sessions. Lesion clearance was evaluated by two specialists on the basis of digital photographs taken before the first treatment and 2 months after the last treatment. RESULTS: Seven patients had an excellent response (clearance rating 75%-100%) and five patients had a good response (clearance rating 50%-75%). Transient purpura and pain were present in all patients. Bleeding during treatment occurred in five patients. There were no permanent side effects. CONCLUSION: Pulsed dye laser is effective and safe for the treatment of angiokeratoma of Fordyce, with minimum side effects, providing an additional nonablative therapeutic option.     

The Effect of Dofetilide on Ventricular Defibrillation Thresholds

Introduction: High defibrillation threshold (DFT) with an inadequate defibrillation safety margin remains an infrequent but troubling problem associated with defibrillator implantation. Dofetilide is a selective class III antiarrhythmic drug that reduces DFTs in a canine model. We hypothesized that dofetilide would reduce DFTs in humans, obviating the need for complex lead systems.
Methods and Results: Sixteen consecutive patients with DFTs ≥20 J delivered energy at implant-received dofetilide therapy and underwent follow-up DFT testing acutely following drug loading and/or chronically (128 ± 94 days). Amiodarone was discontinued in four patients at implantation. With dofetilide, DFTs decreased from 28 ± 4 J to 19 ± 7 J (P < 0.0001), resulting in a safety margin of 15 ± 8 J for the implanted devices. Five patients subsequently had spontaneous arrhythmias terminated successfully with shocks.
Conclusion: Dofetilide reduces DFTs sufficiently to prevent the need for more complex lead systems. This strategy should be considered when an inadequate defibrillation safety margin is present.     

根治性切除术、化疗、放疗、光动力学疗法联合治疗三期乳癌

目的探讨术中光动力学疗法对拓展三期乳癌根治范围的作用。方法三期乳癌患者（T4任何NM0）12例，其中皮肤浸润伴橘皮样外观9例，炎性乳癌3例；N1 9例，N23例。术前给予CEF方案辅助化疗2～3个周期。化疗后手术前48h静点HpD5mg／kg。行根治性切除术。缝合皮肤前进行激光照射，激光波长630nm，光纤末端能量密度270J／cm^2。术后辅助CEF／TAC方案化疗、放疗及内分泌治疗。结果随访3～12个月，胸壁和腋窝局部未见肿瘤残留及复发，肝、肺、胸椎以及对侧乳腺均未见转移。结论化疗、手术、放疗、化疗联合术中光动力学疗法治疗三期乳癌，能够有效地清除残留肿瘤、防止复发和转移。     

The relationship between burnout and job satisfaction in nurses

Nursing is a stressful occupation. This study, carried out on two groups of nurses, confirms the thesis that job satisfaction as measured by the Job Satisfaction Questionnaire designed for this study was a reliable indicator of burnout. It was expected that an inverse relationship between job satisfaction and burnout would be found. The hypothesis was that high job satisfaction would be associated with low burnout. It was found that a relationship exists between job satisfaction as measured by the Job Satisfaction Questionnaire and burnout as measured by the Maslach Burnout Inventory.