Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs.

BACKGROUND. Long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) may lead to inflammation of the small intestine associated with occult blood and protein loss. The aim of this study was to investigate the prevalence and structural correlates of this enteropathy. METHODS. We examined the stomach, duodenum, and small intestine of 713 patients post mortem. Of these patients, 249 had had NSAIDs prescribed during the six months before death and 464 patients had not. All visible small intestinal lesions were removed for histologic examination, and specific etiologic factors were sought. The prevalence of nonspecific small-intestinal ulcers and ulcers of the stomach and duodenum was compared in the two groups of patients. RESULTS. Nonspecific small-intestinal ulceration was found in 21 (8.4 percent) of the users of NSAIDs and 3 (0.6 percent) of the nonusers (difference, 7.8 percent; 95 percent confidence interval, 5.0 to 10.6 percent; P less than 0.001). Three patients who were long-term users of NSAIDs were found to have died of perforated nonspecific small-intestinal ulcers. Ulcers of the stomach or duodenum were found in 54 (21.7 percent) of the patients who used these drugs and 57 (12.3 percent) of those who had not (difference, 9.4 percent; 95 percent confidence interval, 3.9 to 15.1 percent; P less than 0.001). CONCLUSIONS. Patients who take NSAIDs have an increased risk of nonspecific ulceration of the small-intestinal mucosa. These ulcers are less common than ulcers of the stomach or duodenum, but can lead to life-threatening complications.     

Reconstruction of a functional and esthetic nail

The most common cause of nail bed deformity is trauma, but other causes are infection, tumor, ischemia, or congenital anomalies. This article includes discussions of nonadherence, split nail, reconstruction of the eponychium, crooked and hooked nail, bony irregularity, pachyonychia, ischemic deformities, and absence of the nail. New problems are encountered daily and other deformities have no method of correction recorded in the literature. For these cases, we provide suggested treatments based on the anatomy and physiology of the nail.     

Radon dosimetry based on the depth distribution of nuclei in human and rat lungs

Calculation of the absorbed dose by different lung cells is necessary for predicting the critical cells that are subject to injury from inhaled Rn and other alpha-particle sources. The absorbed dose was determined for cells in the airways of human and rat lungs, based on airway epithelial thickness and on cell cytoplasm and nuclear volume density as a function of depth from the luminal surface of the airway epithelium. The thickness of the stratified columnar epithelium of human airways varied from 57.8 micron in bronchi to 9.8 microns in bronchioles. The cell populations of all bronchi in human lungs were comparable. The cell populations of trachea and intrapulmonary airways in rats, however, were significantly different. Basal cell populations in rat trachea and human bronchi were similar and formed a nearly continuous layer. In rat bronchi, basal cells were not present in significant numbers. Measurements of epithelial thickness and volume density were used to estimate the absorbed dose for an alpha-particle source (214Po or 218Po) distributed uniformly in the mucus with an equivalent activity of 1 dpm per cm2 of epithelial surface. The following model predictions of dose to human bronchial epithelial cell nuclei for a 218Po alpha-particle source are provided in units of nanogray (nGy) for specific cell types: secretory 158, preciliated 114, ciliated 44, goblet 86, basal 78, and indeterminate cell nuclei 73. The absorbed dose to specific types of rat bronchial epithelial cell nuclei was also predicted: secretory 237, precillated 216, ciliated 203, goblet 204, basal 200, and indeterminate cell nuclei 166 nGy. These and other results indicate that human and rat airway dosimetry have significant differences that may contribute to the differences in cancer cell induction between the two species.     

Soemmering's ring support for posterior chamber intraocular lens implantation during penetrating keratoplasty. Changing trends in bullous keratopathy.

BACKGROUND: Changing trends in cataract extractions have resulted in a new category of bullous keratopathy: corneal decompensation after complicated extracapsular cataract extraction. These cases of bullous keratopathy are associated with rupture of the posterior capsule, vitreous loss, and significant intraocular inflammation at the time of the original complicated extracapsular cataract extraction. METHODS: The authors reviewed 14 consecutive cases of penetrating keratoplasty for bullous keratopathy in which posterior chamber intraocular lens implantation was supported by remnants of the posterior capsule and/or Soemmering's ring without suture fixation. All 14 patients had a history of complicated extracapsular cataract extraction with capsule rupture and vitreous loss. RESULTS: All 14 patients had clear, compact grafts without migration of the intraocular lens with a mean follow-up of 12.1 months. Vision improved in 93% of cases, and there was no significant worsening of glaucoma. CONCLUSIONS: Pseudophakic bullous keratopathy after traumatic extracapsular cataract extraction with an anterior chamber intraocular lens and aphakic bullous keratopathy after traumatic extracapsular cataract extraction are two relatively new clinical entities that present new intraocular lens management options. Bullous keratopathy after complicated extracapsular cataract extraction should be recognized as a distinct clinical entity. Intraocular lens implantation into the ciliary sulcus with Soemmering's ring and peripheral capsular support provide the advantages of a posterior chamber intraocular lens without the risk of iris or scleral sutures. The authors predict that bullous keratopathy associated with traumatic extracapsular cataract extraction will become one of the more common indications for penetrating keratoplasty.     

Unannounced simulated patients' observations of physician STD/HIV prevention practices.

Studies describing sexually transmitted disease (STD) and human immunodeficiency virus (HIV) prevention practices of primary care physicians have relied on physician or patient reports. This study describes physician STD/HIV prevention practices as observed by unannounced simulated patient evaluators (SPEs). SPEs visited sixty-five primary care physicians. Each SPE portrayed a sexually active female, new to the area, requesting a consultation on STD prevention. One-third of the physicians in the study asked no risk questions, and over 80% failed to ask the SPE specifically about her sexual practices. Most physicians discussed the risks of STDs and HIV and covered basic recommendations (use condoms and know partners better); however, few physicians provided any individualized information or advice about safer sexual practices and the specifics of condom use, such as how to use them or what kind to use. These observations support the low rates of STD/HIV prevention indicated in physicians' self-report and further identify specific deficiencies in the thoroughness of their risk assessment and preventive counseling practices.