Long-term results of Grice subtalar arthrodesis in children

Talipes valgus, mostly resulted from poliomyelitis, of 44 feet in 43 children, aged 4 to 12 years, were treated by Grice extra-articular arthrodesis of the subtalar joint, and on 36 of them tendon transfer was done as well at the same time. The result in all of them, after a period of 15.3 years (ranging 5 to 23 yrs.), was found satisfactory in 32 feet (72.7%), and unsatisfactory in 12 (27.3%). Eight of the latter were found to be due to secondary varus deformity, a consequence of imbalance of muscle power following medial transfer of peroneal tendon (s). It is emphasized that in correcting foot deformity, slight valgus is receptible while over correction (varus) must be avoided. It is also found that after subtalar stabilization, traumatic osteoarthritis of midtarsal and ankle joints developed more frequently in patients who had better limb function than in those whose limbs had functioned much less.     

Amorphous oxide--a platform for drug delivery.

Usually, a drug is loaded onto the metallic surface of a medical device by applying a polymer layer containing the drug. Unfortunately, polymer coatings on the metallic surface may exhibit numerous problems after implantation, such as late thrombosis, inflammation, and restenosis. Current research was conducted to investigate whether a suitable oxide layer can be used as a polymer-free platform for drug loading, especially for cardiovascular stents. The loading of heparin onto, as well as eluting of heparin from, the amorphous oxide film on the 316LVM stainless steel wire was confirmed by experimental studies using cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), electron spectroscopy for chemical analysis (ESCA), high-performance liquid chromatography (HPLC), and activated clotting time (ACT). Evidence shows that amorphous oxide can be an ideal substitute for the polymer coating of drug-loaded stents to minimize metallic corrosion, inflammation, late-thrombosis, and restenosis.     

The HIV-Positive Physician and Disability Insurance

Occupational exposure to HIV is becoming a daily hazard in many emergency departments. Emergency physicians who are protected by disability insurance policies are likely to believe that if they are unable to continue working because of HIV-positive status, their disability policies will provide them with a source of income. Unfortunately, analysis of case law regarding claims under disability policies shows that the law is unlikely to consider an asymptomatic, HIV-positive physician disabled for purposes of payments under disability policies. Therefore, it is necessary for emergency physicians to make sure this issue is resolved before buying and relying on a disability policy so that an anticipated safety net will be operative over the full range of hazards that emergency physicians face.[Lavely R: The HIV-positive physician and disability insurance. Ann Emerg Med June 1994;23:1355-1362.]     

The emergency physician and patient confidentiality: A review

Confidentiality is a promise rooted in tradition, law andmedical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients.³⁴Although confidentiality is an important principle thatshould be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require, a breach of confidentiality. As Beauchamp and Childress noted, “the therapeutic role may sometimes have to yield to ones role as citizen and as protector of the interests of others”.¹⁹ In general, however, circumstances requiring a breach of confidentiality are rare.     

Baclofen intoxication: report of four cases and review of the literature.

Four cases of baclofen intoxication are reported, with a review of 33 cases from the literature. Analysis of these 37 cases suggests that there are two types of baclofen intoxication syndrome. Patients with acute intoxication present with four major clinical manifestations: encephalopathy (disturbance of consciousness and/or seizure), respiratory depression, muscular hypotonia, and generalized hyporeflexia. Patients with chronic intoxication present with hallucinosis, impaired memory, catatonia, or acute mania. The acute intoxication syndrome has a faster onset, shorter duration, more severe clinical manifestations, and higher incidence of seizures than the chronic intoxication syndrome. Baclofen intoxication, although it may cause grave encephalopathic manifestations and electroencephalographic findings, has a benign outcome if actively managed.     

Maxillary and mandibular occlusal photographs

Taking occlusal photographs can be challenging; they are by far the most difficult images to obtain. Achieving an ideal photograph of every arch may not always be possible. In patients with limited range of motion of the mandible, an oversized or hyperactive tongue, an excessive gag reflex, or reduced flexibility of lips and checks, the goal of an ideal occlusal photograph may not be achieved. Nevertheless, patience, practice, and attention to detail can often provide a satisfactory result.     

Transdermal permeation-enhancing activities of some inorganic anions

Effects of sodium salts of various monovalent inorganic anions on transdermal permeation of salicylic acid were investigated. In in-vitro experiment using a Franz-type diffusion cell and excised mouse skin, the permeation-enhancing activities of the sodium salts of inorganic anions were roughly proportional to lyotropic Hofmeister swelling abilities of the anions; F^?<SO₄ ^2?<Cl^? <ClO₄ ^?<NO₃ <SCN^? <Br <I^?, i.e. l, Br and SCN increased the flux of drugs through the mouse skin, while F^?, SO₄ ^2?, Cl^?, ClO₄ ^? and NO₃ ^? decreased or did not affect the flux. In invivo experiment using the rabbit as the test animal, the plasma concentration of salicylic acid of the rabbit to which 10%-salicylic acid ointment containing 5%-Nal or NaBr was applied was significantly higher than that of the rabbit to which the ointment without the electrolytes was applied. The amounts of sterol leached out of stratum corneum sheet when the sheet was immersed in aqueous solutions of Nal, NaBr, or NaSCN were much more than that of stratum corneum immersed in aqueous solutions of the other inorganic anions. The FTIR/ATR spectroscopy showed that the peaks at 2853 cm^?1 and 2924 cm^?1 in the IR absorption spectrum of the stratum corneum sheet of the mouse were shifted to higher frequencies by the anions which enhanced the transdermal drug permeation, while not shifted by the anions which did not have any permeation-enhancing activities or have permeation-reducing activities. These results suggest that sodium salts of some anions such as iodide, bromide and thiocyanate enhance transdermal permeation of salicylic acid through swelling and perturbation of the skin structure by these anions.