Soft-tissue injury associated with closed fractures: evaluation and management

Determination of the severity of injury to the soft tissues is an important component of patient assessment and affects management of closed fractures. The response of soft tissue to blunt injury involves microvascular and inflammatory processes that produce localized tissue hypoxia and acidosis. Incisions placed through such compromised tissue can lead to wound breakdown and deep infection. Therefore, recognizing the signs of soft-tissue injury is the foundation for successful management of closed fractures. Many treatment options, including splinting, cryotherapy, compression, and delayed surgery, help limit further soft-tissue injury and facilitate its rapid recovery before surgical intervention. Emerging surgical techniques based on improved management have resulted in decreased rates of soft-tissue complications.     

St John's wort: Prozac from the plant kingdom

Conventional antidepressants are associated with a range of adverse drug reactions. The herb Hypericum perforatum (St John's wort) might offer another approach to the treatment of depression. Biochemical and animal studies suggest that the phloroglucinol derivative hyperforin is the main active ingredient of St John's wort, and inhibits the synaptosomal uptake of 5-HT, noradrenaline, dopamine, glutamate and GABA. St John's wort has been shown to alleviate symptoms of mild to moderate depression, and seems to offer significant advantages over conventional antidepressants because it is associated with fewer adverse reactions. However, important herb--drug interactions have been described. In view of its efficacy and safety records, St John's wort should be considered for the first-line treatment of mild to moderate depression.     

Smoking-cessation counseling in the home: Attitudes, beliefs, and behaviors of home healthcare nurses

BACKGROUND: Despite advances in smoking treatment, cessation rates remain stagnant, possibly a function of the lack of new channels to reach heavily addicted smokers. This cross-sectional study examined home care nurses' attitudes, beliefs, and counseling behaviors regarding counseling their home care patients who smoke. METHODS: Home healthcare nurses (N=98) from the Visiting Nurse Association of Rhode Island were randomly selected to participate in a study helping home-bound medically ill smokers to quit. At baseline, nurses completed a questionnaire that assessed a constellation of cognitive factors (self-efficacy, outcome expectations, perceived effectiveness, risk perception, motivation, and perceived patient adherence) as correlates of self-reported nurse counseling behaviors. RESULTS: Nurses with higher outcome expectations spent more time counseling their patients about quitting (p<0.04). Nurses' self-efficacy was the only variable associated with consistent counseling (p<0.05). While the majority of nurses "asked and advised" their patients, a minority of nurses "assisted or arranged" follow-up. Perceived importance of counseling was associated with a greater likelihood of asking, advising and assisting (p<0.05). None of the nurses who currently smoked (n=13) provided follow-up to their patients. Nurses who reported higher levels of both risk perception (regarding the harmful effects of smoking) and perceived effectiveness were more likely to recommend the nicotine patch. CONCLUSIONS: Attitudes and beliefs about smoking are significantly associated with nurse counseling behaviors. Helping nurses to overcome their barriers to smoking counseling may open up new channels for smoking intervention.     

Weight control smoking among sedentary women

This study examined characteristics associated with weight control smoking among 281 sedentary women enrolled in a smoking cessation trial. A series of regression models were developed to identify predictors of weight control smoking as measured by the Smoking Situations Questionnaire. Predictor variables included demographic variables, dietary intake, weight gain following previous quit attempts, dietary restraint, self-efficacy for weight management, smoking behavior, exercise behavior, negative affect and psychological constructs relevant to smoking cessation, and exercise adoption. In the final predictor model, anticipation of weight gain in the current quit attempt, higher dietary restraint, younger age, greater Fagerstrom scores, greater number of pounds gained in previous quit attempts, and lower levels of self-efficacy to manage weight in negative affect situations were associated with smoking for weight control. Treatment implications for women who smoke for weight control reasons are discussed.     

Prevention of gestational hypertension with calcium, linoleic acid, mono and polyunsaturated fatty acid supplements]

BACKGROUND: The aim of this study was to evaluate the benefits of calcium, linoleic acid and mono- and polyunsaturated fatty acids in the prevention of gestational hypertension. METHODS: Between January 1999 and June 2000, 65 primagravidas with a risk of gestational hypertension between the 20th and 24th week of pregnancy were recruited using Doppler velocimetry of the uterine arteries and Holter 24-h pressure monitoring. Patients with diabetes, hypertensive gestosis and previous renal pathologies were excluded. The patients were divided into 2 unequal groups: Group A (40 patients) was treated with calcium, linoleic acid, and mono and polyunsaturated fatty acid supplements; Group B (25 patients) received no treatment. The patients in both groups underwent Doppler velocimetry of the uterine arteries and Holter pressure monitoring at 28-30-32-35 weeks of gestation. RESULTS: Calcium linoleic acid and mono and polyunsaturated fatty acid supplements were effective in significantly reducing the incidence of gestational hypertension (p>0.05); in fact 90% of patients in Group A underwent a physiological evolution of pregnancy compared to only 10% affected by gestational hypertension. In the control group the incidence of this pathology was much higher (32%). CONCLUSIONS: The authors conclude that calcium linoleic acid and mono and polyunsaturated fatty acid supplements are useful and effective in the prevention of gestational hypertension in women at risk for this pathology.     

Biologic action of promestriene on the genital tract of the castrated rat

The study assessed the activity of promestrien administered by a local vaginal route in 16 rats castrated 60 days previously. The dose used was 5 mg per day for 10 days. Following treatment, animals were sacrificed and histological analyses revealed a remarkable proliferation of the vaginal epithelium, inhibition and restored trophism of the strome, whereas no estrogen stimulus was observed at the level of uterine mucous. This confirms the exclusively local action of promestrien which does not provoke undesirable side effects on other segments of the genital tract, and allows the therapeutic use of the hormone in different gynaecological pathologies.     

Chylous reflux pathologies: diagnosis and microsurgical treatment.

BACKGROUND: This article aims to make a contribution to the present knowledge of the diagnosis and therapy of chylous reflux pathologies, based largely on the authors' clinical experience in the microsurgical treatment of these disorders. METHODS: In 47 patients affected by chylostatic disorders the diagnosis was based on the clinical history, physical examination, lymphoscintigraphy, lymphography, ultrasound, CT scanning and lymphangio-MR. In cases of chylous reflux towards the external genitalia or the lower limbs, the puncture of one of the lymphostatic verrucae which may be part of the symptomatology, can be sufficient for the clinical diagnosis. If patients suffer from hypoproteinaemia and/or an intestinal malabsorption syndrome, this should be dealt with to ensure them at least temporary metabolic compensation before surgical treatment, if any. In patients affected by chylous ascites, antigravitational ligatures of incompetent collectors, sometimes associated with lymphovenous shunts, can be a therapeutic solution. RESULTS: We have found that CO2 laser irradiation at very low power achieved full section closure of lymphatic and chylous vessels as complete as if they had been tied. In the case of chyloedema of the external genitalia and of/or the lower limbs, reductive plastic treatment completes the result after antigravitational ligatures and derivative microsurgery. CONCLUSIONS: A laser-microsurgical technique used to manage chylous reflux pathologies achieved positive and permanent results, especially after an accurate preoperative diagnostic study to determine the site and nature of the lymphatic and chylous leakage and associated disorders.     

Flavones. 2. Synthesis and structure-activity relationship of flavodilol and its analogues, a novel class of antihypertensive agents with catecholamine depleting properties

(3-Phenyl-7-flavonoxy)propanolamines have been shown to exhibit antihypertensive activity in spontaneously hypertensive rats. Although they are structurally similar to classical beta-adrenergic blocking compounds, their activity is not due to inhibition of beta-adrenoceptors. In the present study, a series of simple flavonoxypropanolamines was prepared to further explore the structural requirements for the antihypertensive effect of these compounds. A structure-activity relationship of these derivatives indicates that the position of the oxypropanolamine side chain, the hydroxy group of the side chain, steric bulkiness and length of N substituents, degree of the N-substitution, phenyl group at the 2-position of the chromone nucleus, and substituents of the phenyl group or B ring of the flavone play significant roles in imparting pharmacological effects. In addition, there is a good correlation between the antihypertensive activity and depletion of myocardial norepinephrine. Of these analogues tested, the most effective one was flavodilol. Only the 8-substituted analogue 6 was found to be a beta-antagonist. Flavodilol was chosen for in-depth pharmacological, toxicological, and clinical evaluation.