A retrospective study of diabetic foot ulcers treated with hyperbaric oxygen therapy

A retrospective review of patient medical records was conducted to assess what factors influence the outcomes of diabetic foot ulcers treated with hyperbaric oxygen (HBO) therapy. Patients referred to the Diving Diseases Research Centre for HBO therapy for the treatment of diabetic foot ulcers during a 2‐year period were included in this study. Data collected from 30 sets of patient records were entered into SPSS and statistical analysis was undertaken to investigate whether any underlying pathologies or confounding factors appeared to influence patient outcome. A 73·3% of patients achieved a successful outcome of partial healing, major amputation no longer required, amputation level lower than anticipated prior to HBO or healing at the end of HBO therapy and 70% remained successful 3 months later. A 13·3% of patients were lost to follow‐up at 3 months and one patient (3·3%) had a major amputation. Steroid therapy, peripheral vascular disease, previous minor amputation, type of diabetes, previous HBO therapy, larvae therapy, the use of interactive dressings and haemoglobin A1c levels were all observed to have had a significant relationship with patient outcome (P < 0·05). These results were compared with data from other published research conducted in this area on similar patient groups. A larger scale study focussing on the factors found to be significant in this study is recommended. An improvement of patient documentation would allow patient outcomes to be more consistently monitored in the future.     

The quality of medical teaching and learning in rural settings: the learner's perspective

Summary. During 1992–93, the authors produced a video-based teacher development resource kit for rural and isolated general practitioners and hospital medical personnel who are involved in medical teaching. As part of the development process, we surveyed 240 medical undergraduate students of the University of Queensland about their experiences and perceptions of teaching and learning in rural settings in Queensland. For approximately 90% of undergraduate learners, the experience with a rural medical practitioner was extremely positive. The major positive features identified by students were: being treated as a colleague; being allowed/encouraged to work independently; receiving feedback on their work; and being given ample 'hands-on' minor procedural experience and/or teaching. The 10% of students who reported unfavourably on their rural terms identified lack of opportunities to carry out solo consultations/work independently, lack of structure in teaching/learning experiences, and lack of hands-on experience as the major disappointments. The results demonstrate clearly how and why the majority of rural medical teachers in Queensland are effective facilitators of undergraduate learning.     

Multiplanar imaging of the hip: a systematic approach

Computed tomography has become an invaluable adjunct for the evaluation of musculoskeletal pathology. Although the transaxial image presentation has distinct advantages over conventional radiography, the ability to reformat the acquired data into coronal, sagittal, or oblique planes contributes to a more thorough understanding of complex anatomy such as that of the hip joint. This article reviews our experience with a series of over 500 hip cases using the multiplanar reformatting and display [MPR/D] package developed for use on the Siemens Somatom DR-3 scanner.     

Incisional hernia: a 10 year prospective study of incidence and attitudes

Five hundred and sixty-four patients reviewed 1 year after major abdominal surgery have been studied prospectively by a single observer for 10 years to determine the incidence and significance of incisional hernia. Of 337 (60 per cent) patients completing the 10 year follow-up 37 (11 per cent) developed an incisional hernia and 13 (35 per cent) of these first appeared at 5 years or later. One in three hernias caused symptoms. The late appearing hernias were smaller than the early ones, and caused little trouble. Of the 18 patients who consulted their general practitioner, 11 had symptoms and of these six (55 per cent) were referred for surgical opinion. Many hernias were diagnosed at routine outpatient follow-up and were likely to receive treatment from the surgeon. Most symptomatic patients were offered surgery with the remainder usually being offered a corset. In about half our patients (mainly those without symptoms) surgery was refused or advised against although the patients would have accepted it. Recurrence is common after surgical repair (40 per cent) but seems to be related to surgical technique. The possibility of complications occurring from an incisional hernia does not appear to be discussed with patients although obstruction occurred in 14 per cent of our patients with troublesome hernia.     

Nephrotoxicity of p-aminophenol,a metabolite of acetaminophen,in the Fischer 344 rat

Acetaminophen (APAP) produces proximal tubular necrosis in the Fischer 344 rat. APAP is deacetylated to p-aminophenol (PAP) in the hamster, and PAP has been reported to be a potent specific cortical nephrotoxicant in the rat. However, the role of PAP in APAP nephrotoxicity has not been defined. Therefore, it was of interest to quantify PAP formation after APAP administration and to correlate PAP formation with renal injury produced by APAP in the Fischer 344 rat. Urinary PAP excretion, measured as an index of PAP formation, increased with increasing doses of APAP. In addition, APAP was metabolized to PAP in isolated perfused kidneys. PAP at doses as low as 100 mg/kg produced significant renal toxicity (elevation in blood urea nitrogen and reduction in accumulation of p-aminohippurate by thin renal cortical slices). Ortho- and meta-aminophenol were not nephrotoxic. Pretreatment with polybrominated biphenyls or β-naphthoflavone, inducers of mixed function oxidases, protected against nephrotoxicity of PAP, possibly as a result of enhanced hepatic biotransformation of the parent compound. These studies indicate that PAP is a potent, selective nephrotoxicant that can be generated from APAP by the kidney and may be responsible for the renal necrosis subsequent to APAP administration.