The use of the distal Syme's procedure for treating onychopathy

There are many procedures available to the podiatric surgeon to deal with a painful, deformed nail. The Syme's procedure should not be overlooked, though more conservative options should be attempted before this procedure. With the proper surgical candidate (ie, intact neurovascular status), this is a successful, safe procedure easy to perform under local anesthesia.     

Vitamin D receptor gene polymorphism in hypercalciuric children

Idiopathic hypercalciuria is a complex disease resulting from an interaction between environmental and genetic factors. Recently, the relationship between vitamin D receptor (VDR) alleles and calcium homeostasis has been investigated. This study was conducted to explore the association of VDR gene polymorphism with the risk of absorptive hypercalciuria (AH). We investigated the VDR gene polymorphisms, ApaI, BsmI, and TaqI, in relation to intact parathormone (PTH), osteocalcin, and 25-hydroxyvitamin D in 80 children (42 males, 38 girls) with AH and in 86 healthy children without hypercalciuria. A significant difference in the ApaI genotype was observed between the AH group and the control group (²=7.21, P=0.027). The AA genotype was associated with a 3.5-fold increased risk for idiopathic hypercalciuria compared with the Aa/aa genotype (odds ratio 3.5, 95% confidence interval 1.1–11). The BsmI and TaqI polymorphisms did not show any significant association with AH. Serum osteocalcin levels were significantly higher in the group with the AA genotype compared with those with the Aa or aa genotype (P=0.02, P=0.05, respectively). The results indicate that the ApaI AA genotype of the VDR gene is not only associated with AH but is also related to differences in serum osteocalcin.     

Increasing pharmacy productivity by expanding the role of pharmacy technicians.

Efforts to meet growing clinical and distributive demands without increasing pharmacy staff are described. Real and expected increases in demands for services led pharmacists at a cancer center to seek ways of accommodating those demands within budgetary limits. Growth in the distributive workload was interfering with clinical consultation work. Research studies by the medical staff were resulting in complex dosage calculations and time-consuming compounding. Increasing requests for clinical services had to be met without compromising distributive services and teaching responsibilities and without raising costs. A plan of action was approved that included the use of a written test and a training manual to allow the hiring and retaining of skilled pharmacy technicians qualified to assume greater responsibilities. Technicians were assigned to enter drug orders into the computer, check other technicians, and dispense certain drugs. Greater use was made of commercially prepared i.v. solutions, and the floor stock was expanded. A comprehensive quality control program was concurrently put in place. The larger role for technicians not only enabled the pharmacy department to increase its distributive workload dramatically but reduced pharmacy medication errors and provided more time for clinical pharmacy practice. The number of pharmacist and technician full-time equivalents increased by only 1.5 in each category between 1985 and 1990. By making more use of pharmacy technicians, a pharmacy department was able to meet escalating demands for services with only a minor increase in personnel.     

Results of conventional detachment surgery. I. Study planning, patients and vision results]

A consecutive series of patients with retinal detachment were examined. All patients were treated primarily with buckling procedure. Patients with redetachment, bilateral detachment, vitrectomy or history of strabismus or amblyopia were excluded. Of these 155 patients, 117 could be examined. 97% of patients without macula detachment are able to keep or improve their visual acuity. 85% of those patients with macula detachment showed an improvement of visual acuity. The most important prognostic factor for the visual outcome is the duration of macula detachment. In cases of more than four days duration a visual acuity of 20/40 or more could not be expected.     

Atrial fibrillation: epidemiology and the risk and prevention of stroke.

Atrial fibrillation is a common disorder and the incidence increases with each decade of life. Previously, rheumatic mitral valve disease has been the condition most highly associated with atrial fibrillation. However, with the decreasing incidence of rheumatic heart disease, other conditions have assumed greater importance and now congestive cardiac failure, coronary artery disease, and hypertension are the most commonly associated conditions. Nonrheumatic atrial fibrillation is associated with an approximately five-fold increase in the risk of ischemic stroke and a 5% to 7% yearly risk that increases with age. In addition, atrial fibrillation is associated with an increased incidence of silent cerebral infarction and increased mortality. However, whether atrial fibrillation is independently associated with the risk of stroke or is a marker of underlying cardiac disease is contentious. Until recently, the use of preventive therapy has been controversial. However, data from four recently published, prospective randomized studies clearly support the use of warfarin prophylaxis in nonrheumatic atrial fibrillation. Within the diverse group of patients with nonrheumatic atrial fibrillation there are high and low risk subgroups and identification of these may influence decisions regarding antithrombotic prophylaxis. With a few exceptions, however, this remains an area in which there are contradictory findings in the literature. The role of aspirin for prophylaxis in nonrheumatic atrial fibrillation remains unclear and further evaluation awaits the publication of ongoing studies.     

Folate analogues. 26. Syntheses and antifolate activity of 10-substituted derivatives of 5,8-dideazafolic acid and of the poly-gamma-glutamyl metabolites of N10-propargyl-5,8-dideazafolic acid (PDDF)

The poly-gamma-glutamyl derivatives of n10-propargyl-5,8-dideazafolic acid (PDDF) with a chain length of up to five glutamate residues were synthesized from N10-propargyl-5,8-dideazapteroic acid by the solid-phase procedure. These compounds were evaluated for their antifolate activity using folate-requiring microorganisms and intact and permeabilized L1210 cells and as inhibitors of dihydrofolate reductase and thymidylate synthase derived from L. casei. The polyglutamylated derivatives of PDDF (1) were more active than the parent compound in inhibiting the growth of L. casei, thymidylate synthesis in permeabilized L1210 cells, and L. casei thymidylate synthase. Two analogues of 5,8-dideazafolic acid (2 and 3), one with a 2-butyne and another with a cyclopropylmethyl substituent at N10, were also synthesized and evaluated for their antifolate activities using the above-mentioned test systems. They were considerably less active than PDDF or its polyglutamylated derivatives. N10-Propargyl-5,8-dideazapteroyl tri-, tetra-, and pentaglutamates were equipotent with 5-fluorodeoxyuridylate as inhibitors of thymidylate synthesis in permeabilized L1210 cells. The polyglutamyl metabolites of PDDF were shown to be the most potent antifolate inhibitors of L. casei and L1210 thymidylate synthases yet described.     

Brucellae osteoarthritis on the head of the femur

We present an 11-year-old boy with Brucellae osteoarthritis on caput femoris. We therefore emphasize the importance of Brucellae osteoarthritis and in particular bone scintigraphy in the diagnosis of childhood monoarthritis.