Successful treatment of acute head and neck dog bite wounds without antibiotics

Dog bites continue to be the most common bite injury in the United States. We previously reported a series of 61 patients with 215 dog bite wounds. Of these, 55 patients had 188 dog bite wounds of the head and neck area which were treated with copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic coverage, wound closure, and close postoperative monitoring. A wound infection rate of .53% and a patient infection rate of 1.8% were obtained using this protocol. Our present study uses the same protocol with the exclusion of antibiotic coverage. Our series of 49 patients with 145 head and neck wounds reveals a wound infection rate of 1.4% and a patient infection rate of 4%. This is not statistically significantly different from the outcome of the previous study.     

Kikuchi-Fujimoto's disease: report of 5 cases and literature review]

Kikuchi-Fujimoto's disease or histiocytic necrotizing lymphadenitis is a benign disease predominantly occurring in young women which etiology remains unknown and revealed by cervical lymphadenitis and/or prolonged fever. It has rarely been reported in children. Among the 5 cases reported, 1 child had a systemic localization. The diagnosis is based on the histological examination of a lymph node biopsy. The disease course was spontaneously favourable in 2 cases; a corticotherapy was needed in 3 children. A pathogen agent was found in 2 patients. Kikuchi's disease can reveal or evolve into autoimmune disease particularly lupus, thus a long clinical and biological follow-up is necessary.     

Implementation of a Patient Charting System: Challenges Encountered and Tactics Adopted in a Burn Center

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. In this light, the aim of this study is to provide a deeper understanding of how clinical information systems are being implemented by emphasizing research efforts on the dynamic nature of the process, that is, the “how” and “why” of what happened. Using a case study methodology, we examined the implementation of a patient charting system in the Burn Center of a large, not-for-profit, teaching hospital. Based on an in-depth examination of this implementation, several insights are offered to those who have responsibility for managing complex and risky clinical information system implementation projects.     

Staged bilateral thalamic electrode implantation utilizing frameless stereotactic guidance.

Deep brain stimulation (DBS) for medically intractable Parkinson's disease (PD) is well established, but carries the inconveniences of frame-based neurosurgery. Previous reports have demonstrated that ventricular shunt placement and some functional procedures can be accurately performed using frameless stereotaxy. We present a report indicating that staged deep brain electrode placement can be accurate and efficacious using a frameless skull-mounted guide.     

Selective attention to facial emotion and identity in schizophrenia.

The selective attention to facial emotion and identity was investigated in 12 patients with schizophrenia and 12 healthy participants. Both patients and controls were required to perform two classification tasks (according either to identity or emotion). Two separate values for identity (person A/person B) and for emotion (fear/anger) were used. When the classification task was on one dimension, the other dimension was either correlated, constant, or orthogonal (Garner WR. The Processing of Information and Structure. Potomac, MD: Erlbaum, 1974, Garner WR. Interaction of stimulus dimensions in concept and choice processes. Cognitive Psychology 1976;8:98-123). Results indicated that both patients and healthy participants had an asymmetrical pattern of performance: they were able to selectively attend to the identity of the face presented, regardless of the emotion expressed on the face, but variation in identity interfered with the classification of facial emotion. Moreover, a correlational study indicated that the identity interference on emotion classification for schizophrenic patients covaried with the severity of their negative symptoms. The selective attention competencies in schizophrenia and the independence hypothesis of emotion and face recognition are discussed in the framework of current face recognition models.     

Measurement of tibial torsion--a new technique applicable to ultrasound and computed tomography.

A new method for measuring tibial torsion is described which can be applied to both ultrasound (US) and computed tomography (CT). The method has been validated in dry tibiae by comparison with direct measurements and with Jend's established CT method. In clinical practice a good statistical level of agreement has been demonstrated between the values obtained from US and CT scans. Both compared well with values obtained using Jend's CT technique. The use of US avoids exposure to radiation and is therefore suited to studying young subjects and controls and making repeat measurements.     

Glycemic Carbohydrate: An International Perspective

Attention to the different types of carbohydrates and their role in health and disease is relatively recent. FAO and WHO jointly published a report on carbohydrates in human nutrition in 1998, with a number of recommendations about increasing carbohydrate intake as a sound approach to the prevention of obesity. The glycemic index (GI) was recommended as a means of classifying foods on the basis of their potential for raising blood glucose; this concept was based on the understanding that the state of hyperglycemia that is observed following the intake of certain high-GI carbohydrate foods could constitute a risk factor for diseases of lifestyle.