Verrucous hyperplasia: a common and problematic finding in the high-risk diabetic foot

Although verrucous hyperplasia may be common in high-risk insensitive feet, the literature contains little discussion on this topic. Treatment of verrucous hyperplasia is aimed primarily at reducing the causative forces. In cases that result from edema, external compression has proved to be adequate. If verrucous hyperplasia on the foot results from frictional forces, then shoe modifications with proper fit, accommodative liners, or fillers in the case of amputation are necessary. In recalcitrant cases, excision of the affected tissue with local soft-tissue or graft coverage has been successful. We describe a 56-year-old man with verrucous hyperplasia.     

Biomechanical evaluation of a rotator cuff defect model augmented with a bioresorbable scaffold in goats

A bioresorbable patch used for augmentation of rotator cuff repair was evaluated to determine if it would increase strength of cuff repairs associated with tendon defects and also show histologic incorporation over time. Forty goats underwent rotator cuff repairs of the infraspinatus tendon bilaterally. Tendons were detached and a defect was created prior to repair. One side was repaired and augmented with a 4 cm2 polylactic acid patch in each animal. On the other side, the same size defect was repaired in the same manner but without the patch to serve as a control. Animals were sacrificed at 3, 6, 12, and 24 weeks. Ultimate load to failure and histology were reported. No significant difference in load to failure was found between groups. A cellular fibrous tissue occupied the patch at 6 weeks, which over time matured into a dense, homogeneous fibrous tissue with alignment of collagen between the scaffold bundles.     

Nutrition problems in an obesogenic environment

Many claims about nutrition and weight loss stem from small, short-term studies, incorrect interpretations or distortions of evidence. Our knowledge of what people eat is poor; difficulties include accurate assessment of consumption, the complex composition of foods and individual variations in nutrient bioavailability. When advice appears to be ineffective, poor compliance is a likely explanation. There is no simple solution to obesity, and no fast way to create the energy deficit required for sustainable loss of fat - weight loss requires long-term commitment to permanently change eating and exercise habits. Valid advice is to reduce overall energy intake, include more vegetables, fruits and whole grain products and fewer foods high in saturated fat, sugar and salt. While mindful of the need to encourage individuals to make changes, the medical profession needs to lead the charge to advocate for changes to our obesogenic environment.     

A review of important contributions of surgery for cancer of the gastrointestinal tract

Summary Although many of the surgical procedures and methods used today in the treatment of cancer of the gastrointestinal tract are not new, they are being used with far better results than were previously obtained because of the introduction of chemotherapeutics and antibiotics late in the 1930's. Safe blood transfusions, better anesthesia, and understanding of fluid and electrolyte balance have also been major contributing factors to surgical progress.Various important procedures and contributions can still be made in the surgeon's everlasting struggle with inflammatory and malignant disease of the intestinal tract.The Mayo Foundation is a part of the Graduate School of the University of Minnesota.Section of Surgery (C.W.M.); Fellow in Surgery, Mayo Foundation (J.W.N.).     

Brief report on the experience of using proxy consent for incapacitated adults

The Medicines for Human Use (Clinical Trials) Regulations 2004, which came into force in the UK in May 2004, cover the conduct of clinical trials on medicinal products. They allow a legal representative (a person not connected with the conduct of the trial) to consent to the participation of incompetent adults in medical research. Currently, very little is known about how such representatives will make their decisions.We have experience with proxy consent for older adults in a large, national trial. From 2445 potentially eligible but incapacitated patients, proxy, relative assent resulted in trial participation of only 87 (3.6%) patients. The reasons for this were that a large number of incapacitated patients had no relative available for assent (2286), but also a high proportion of relatives approached refused to provide assent (72/159, 45.3%). In comparison, 17.7% of patients declined participation in the trial.Proxy consent allowed only a small increase in trial recruitment of incapacitated patients. The fact that a greater proportion of relatives than patients refused to provide assent implies that they were more cautious than the patients themselves, or perhaps used different criteria, when making their decision.In future research involving incapacitated older patients there is likely to be heavy reliance on proxy consent provision by legal representatives. Our findings imply that consent decisions of legal representatives will not necessarily reflect those of patients themselves.     

A follow-up study of the first 70 admissions to a general purpose adolescent unit

A follow-up study of the first 70 admissions to a general purpose adolescent unit. The adolescentS and their families were given individual interviews. The outcome, which was assessed on the basis of these interviews, included psychiatric symptomatology and three basic areas of functioning: social, sexual and work adjustments. A global rating of the general level of function, relative to normality, was given for each adolescent. One third of the adolescents were functioning at a high level, one third were functioning at a moderate level and one third were severely handicapped in the most essential areas of functioning. The study group appeared to be disadvantaged socially and in the work situation. Results suggested that the optimum length of stay was 5-25 weeks. The nature of discharge was important: those adolescents who completed treatment were more likely to have a better outcome than those discharged prematurely.