Terra Firma‐forme Dermatosis in a 4‐Month‐Old Girl

Abstract: Terra firma‐forme dermatosis (TFFD) is an idiopathic condition characterized by asymptomatic, dirtlike, thinly papillomatous, hyperpigmented plaques which cannot be removed with routine cleansing, but clear with firm wiping with 70% isopropyl or ethyl alcohol. Commonly involved sites include the neck, trunk, and umbilicus. Most reports have described adolescents or young adults with a history of normal hygiene and vigorous but unsuccessful attempts at cleansing the affected areas. We describe a 4‐month‐old girl with TFFD, who is the youngest patient thus far reported with this condition.     

Mutans streptococci colonization associates with the occupation of caretaker,a practise‐based study

International Journal of Paediatric Dentistry 2010; 20: 144–150 Background. The early mutans streptococci (MS) bacteria colonization is connected to early childhood caries. The aim of this study is to examine associations between the MS‐colonization and background factors in young children, in order to enhance the oral health program in a low caries prevalence community. Subjects and Design. An age cohort of 512 children was screened for MS in the oral biofilm at the age of 18 months. The caretakers were, using a structured form, interviewed of demographical factors and habits connected to oral health: antibiotic treatments, child’s appetite, frequency of night feeding, use of sugary products or drinks, and maternal xylitol use. The associations were evaluated with logistic regression analysis. Results. Mutans streptococci colonization was significantly associated with both the occupation of the caretaker and the non‐Finnish background. Conclusion. The early MS‐colonization, in preschool children, strongly associates with the socioeconomic status of the family.     

Low‐Risk Profile for Malignant Ventricular Arrhythmias and Sudden Cardiac Death after Surgical Ventricular Reconstruction

Background: Although it has been recently demonstrated that there was no significant difference in total survival and clinical outcomes between patients who underwent coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR), the question of whether or not SVR decreases the arrhythmic risk profile in this population has not been clarified yet. Objective: To determine the real incidence of sudden cardiac death (SCD) and sustained ventricular tachycardia/ventricular fibrillation (sustained VT/VF) in patients following CABG added to SVR and to define their clinical and echocardiographic parameters predicting in‐hospital and long‐term arrhythmic events (SCD + sustained VT/VF). Methods: Pre‐ and postoperative clinical and echocardiographic values as well as postoperative electrocardiogram Holter data of 65 patients (21 female, 63 ± 11 years) who underwent SVR + CABG were retrospectively evaluated. Results: Mean follow‐up was 1,105 ± 940 days. At 3 years, the SCD‐free rate was 98% and the rate free from arrhythmic events was 88%. Multivariate logistic analysis identified a preoperative left ventricular end‐systolic volume index (LVESVI) > 102 mL/m² (odds ratio [OR] 1.4, confidence interval [CI] 1.073–1.864, P = 0.02; sensitivity 100%, specificity 94%) and a postoperative pulmonary artery systolic pressure (PASP) > 27 mmHg (OR 2.3, CI 1.887–4.487, P = 0.01; sensitivity 100%, specificity 71%) as independent predictors of arrhythmic events. Conclusions: Our and previous studies report a low incidence of arrhythmic events in patients following SVR added to CABG, considering the high‐risk profile of the study population. A preoperative LVESVI > 102 mL/m² and a postoperative PASP > 27 mmHg had a good sensitivity and specificity in predicting arrhythmic events. (PACE 2010; 33:1054–1062)     

Transcutaneous Cardiac Pacing for Termination of Tachyarrhythmias

ALTAMURA, G., ET AL.: Transcutaneous Cardiac Pacing for Termination of Tachyarrhythmias. Transcutaneous cardiac pacing (TCP) was used for interruption of tachyarrhythmias in 31 patients: 20 with ventricular tachycardia (VT); eight with atrioventricular reentrant tachycardia (AVRT) and three had atrioventricular nodal tachycardia (AVNT). The stimulators used (Pace Aid 50/52) allow pacing at programmable rates (50–160 ppm) and output (10–200 mA at 20-msec pulse duration), when possible overdrive pacing was used. Short bursts of stimuli were delivered with increasing current intensity until interruption of the arrhythmia or to the maximum energy tolerated by the patient. VTs were interrupted in eight of the 20 patients: four of the six (67%) treated by overdrive pacing and four of the 14 (29%) were treated by underdrive pacing. Supraventricular tachycardias (SVT) were terminated in eight of the 11 patients: seven out of eight (88%) AVT, and one out of three AVNT (33%). We observed two cases of arrhythmia worsening: a VT acceleration and induction of ventricular fibrillation in a patient with AVNT. TCP was well tolerated by the majority of the patients. We conclude that TCP is an effective method for interruption of ventricular and supraventricular reentrant tachycardias, but the risk of arrhythmia worsening must be considered.     

Comparison of α- and β-Hydroxy Acid Chemical Peels in the Treatment of Mild to Moderately Severe Facial Acne Vulgaris

BACKGROUND Chemical peels are used as adjuvants for treatment of facial acne. No well-controlled studies have compared α- and β-hydroxy acid peels in the treatment of mild to moderately severe facial acne.
OBJECTIVE To compare the efficacy of α- and β-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris.
MATERIALS AND METHODS Twenty patients were recruited in this split-face, double-blind, randomized, controlled study. An α-hydroxy acid (30% glycolic acid) was applied to one-half of the face and a β-hydroxy acid peel (30% salicylic acid) was applied contralaterally every 2 weeks for a total of six treatments. A blinded evaluator performed quantitative assessment of papules and pustules.
RESULTS Both chemical peels were significantly effective by the second treatment ( p <.05) and there were no significant differences in effectiveness between the two peels. At 2 months posttreatment, the salicylic acid peel had sustained effectiveness. More adverse events were reported with the glycolic acid peel after the initial treatment.
CONCLUSION The glycolic acid and salicylic acid peels were similarly effective. The salicylic acid peel had sustained effectiveness and fewer side effects. α- and β-Hydroxy acid peels both offer successful adjunctive treatment of facial acne vulgaris.     

FROM STATES OF CONFUSION TO A NATIONAL ACTION PLAN FOR DEMENTIA CARE: THE DEVELOPMENT OF POLICIES FOR DEMENTIA CARE IN AUSTRALIA

The release of Australia's National Action Plan for Dementia Care in 1992 was the culmination of more than a decade of policy development over which the federal government assumed an increasing role, and the participatory approach fostered under its Social Justice Strategy promoted collectivist and political attempts to address the issues of dementia care. This article begins with an account of four phases of policy development, with the transition from one to the next marked by changes in thinking about dementia care being incorporated into policy and then expressed in programmes and in care practices. In the second part of the article, the goals and structure of the National Action Plan are outlined and its implementation and outcomes discussed. Continuation of the policy climate in which the National Action Plan was formulated is a crucial, but uncertain, factor for future development. © 1997 John Wiley & Sons, Ltd.     

Level of Confidence in Diagnosis: Clinical Examination Versus Dermoscopy Examination

BACKGROUND: Confidence is an important factor in decision making and may influence patient care. OBJECTIVES: To evaluate whether short-training-based dermoscopy increases confidence in the diagnosis of skin lesions. METHODS AND MATERIALS: After a 1-hour course on dermoscopy, 20 pairs of clinical and dermoscopic images of lesions were presented to 19 dermatology residents with little or no dermoscopy experience. After viewing the clinical image, they were asked to assess their confidence in the diagnosis in a seven-point scale, with 1 reflecting that the respondent was 100% confident that the lesion was benign, while number 7 reflected 100% confidence that it was malignant. The same technique was used for dermoscopic images. RESULTS: Ten of the 20 pairs of evaluations showed a significant difference (p<.05). The largest differences were observed in lesions where clinical scores suggested that participants were uncertain about the diagnosis, but tended to decide that the lesion was benign after dermoscopy. Dermoscopy did not improve confidence in the evaluation of dysplastic lesions as well as lesions with obvious clinical diagnoses. CONCLUSIONS: Short-training-based dermoscopy improved confidence in the diagnosis of clinically challenging skin lesions, but the impact was not demonstrable for clinically obvious lesions and dysplastic nevi.