Venous thrombosis after hallux valgus surgery

BACKGROUND: Although surgery for the treatment of hallux valgus is frequently performed, the exact rate of deep vein thrombosis following this procedure is unknown. We performed a single-center, prospective, phlebographically controlled study to quantify the rate of venous thrombosis following operative correction of hallux valgus. METHODS: Consecutive patients undergoing chevron bunionectomy for correction of hallux valgus deformity were enrolled in the study. Patients with clinical or hematological risk factors for venous thrombosis were excluded. One hundred patients with a mean age of 48.9 years were operated on and did not receive medical prophylaxis against thrombosis. All patients were assessed with phlebography at a mean of twenty-nine days postoperatively. RESULTS: Venous thrombosis was found in four patients (4%). The mean age of these patients (and standard deviation) was 61.7 +/- 6.1 years compared with a mean age of 48.4 +/- 13.9 years for the patients in whom thrombosis did not develop (p = 0.034). CONCLUSIONS: Patients are at a low risk for venous thrombosis following surgical treatment of hallux valgus. The need for prophylaxis against thrombosis should be calculated individually for each patient according to his or her known level of risk. Routine medical prophylaxis against thrombosis might be justified for patients over the age of sixty years.     

Prophylaxis against possible human immunodeficiency virus exposure after nonoccupational needlestick injuries or sexual assaults in children and adolescents

BACKGROUND: Nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) for adults has been described, although the Centers for Disease Control and Prevention, Atlanta, Ga, offer no specific recommendations. There is limited information about its use in children and adolescents. OBJECTIVE: To describe the current practices of physicians in pediatric infectious disease (PID) and pediatric emergency medicine (PEM) departments regarding nonoccupational HIV PEP for children and adolescents. DESIGN: Survey. PARTICIPANTS: Directors of all PID and PEM departments with fellowship programs in the United States and Canada between July and November 1998. MAIN OUTCOME MEASURES: General questions regarding HIV PEP and questions concerning 2 scenarios (5-year-old with a needlestick injury and a 15-year-old after sexual assault). RESULTS: The return rate was 67 (78%) of 86 for PID and 36 (75%) of 48 for PEM physicians. Fewer than 20% of physicians reported institutional policies for nonoccupational HIV PEP; 33% had ever initiated nonoccupational HIV PEP. In both scenarios, PID physicians were more likely than PEM physicians to recommend or offer HIV PEP in the first 24 hours after the incident (55 [83%] of 66 vs 20 [56%] of 36 for needlestick injuries [odds ratio, 4.0; 95% confidence interval, 1.6-10.1] and 47 [72%] of 65 vs 16 [50%] of 32 for sexual assault [odds ratio, 2.6; 95% confidence interval, 1.1-6.3]). Seven different antiretroviral agents in single, dual, or triple drug regimens administered for 2 to 12 weeks were suggested. CONCLUSIONS: Although few physicians reported institutional policies, and only one third had ever initiated HIV PEP, many would offer or recommend HIV PEP for children and adolescents within 24 hours after possible HIV exposure. A wide variation of regimens have been suggested. There is a need for a national consensus for nonoccupational HIV PEP.     

Measurement of immunoglobulins in seminal fluid with modified nephelometry--an alternative diagnostic tool for chronic prostatitis

The objectives of the study were to investigate the feasibility of the modified nephelometry technique to measure immunoglobulin G and A in seminal fluid and to evaluate their use in diagnosis and follow-up of chronic prostatitis.IgG and A in seminal fluid of healthy individuals (HI) and chronic prostatitis patients (CP) were measured with modified nephelometry. The literature values were confirmed. IgG reflects the long-term healing process of chronic prostatitis. IgA was significantly increased in patients with exacerbation of the disease. Nephelometry proves to be a reliable and inexpensive test to obtain IgG and IgA in seminal fluid. IgG and IgA are useful as objective parameters to confirm subjective symptom scores in a chronic prostatitis research setting.     

An fMRI study of simple ethical decision-making

Recent functional neuroimaging studies suggest that ventromedial prefrontal cortex (vmPFC), left posterior superior temporal sulcus (pSTS) and posterior cingulate cortex are engaged during moral decision-making on complex dilemmatic or salient emotional stimuli. In this fMRI study we investigated which of these brain regions are activated during simple ethical decision-making about unambiguous scenarios not containing direct bodily harm or violence. Simple moral decisions compared to semantic decisions resulted in activation of left pSTS and middle temporal gyrus, bilateral temporal poles, left lateral PFC and bilateral vmPFC. These results suggest that pSTS and vmPFC are a common neuronal substrate of decision-making about complex ethical dilemmas, processing material evocative of moral emotions and simple ethical decision-making about scenarios devoid of violence and direct bodily harm.     

Inguinal Hernia Repair in the New Millennium: Plug and Patch Repair with Local Anesthesia

Plug and patch repair is a safe, economic method for repairing inguinal hernias, with patient comfort comparable to that with laparoscopic hernia repair. The technique is simple to perform under local anesthesia and easily learned without a learning curve. Complications are rare, and recovery and return to work are rapid. After performing plug and patch repair on 400 patients with a follow-up examination rate of 93% and a median postoperative observation time of 42 months, we have recorded a recurrence rate of only 0.25%.     

AIDS and state developmental disability agencies: a national survey.

A survey of state developmental disability agencies was undertaken in October 1987 regarding AIDS policy development, education, and training and service provision. Of 44 states responding to the 27-item questionnaire, only 21 had formal AIDS policies. Policies varied considerably from state to state. Twenty-five of the responding states include information on AIDS in their staff training curriculum, with such training more likely to be provided to institutional staff than to community-based staff. Only 10 states reported AIDS prevention to be part of their client training programs, with training more likely to be found in institutional settings. Eleven states reported HIV positive cases, with such cases found more often in institutions than in community settings. Several states reported some type of segregation of HIV positive individuals. Policies, educational programming, and services to meet the special needs of persons with developmental disabilities are called for.     

Psycho-neurogene Faktoren bei der Genese lebensbedrohlicher Arrhythmien

Tachyarrhythmien treten h?ufig w?hrend erh?hter psychischer Erregung auf. Bei Patienten, bei denen ein Kardioverter Defibrillator (ICD) implantiert wurde, lassen sich arrhythmische Episoden und deren Onset-Zeitpunkt exakt aufzeichnen und erlauben so einerseits die Differenzierung der aufgetretenen Rhythmusst?rung und andererseits eine detailliertere Analyse der situativen Umst?nde und m?glicher an der Ausl?sung beteiligter psychischer Komponenten. In der vorliegenden einzelfallbezogenen Studie wurden bei 3 m?nnlichen Patienten im Alter zwischen 60 und 68 Jahren, bei denen der ICD erfolgreich eine ventrikul?re Tachykardie terminiert hatte, die ICD-Protokolle und die damit korrespondierenden Patientenaussagen analysiert. Die Analyse der akuten Onset-Bedingungen konnte ausgepr?gte Zusammenh?nge zwischen lebensbedrohlichen Herzrhythmusst?rungen in natürlicher Umgebung und emotionalen Stressoren aufdecken. Als Stressoren wurden unterschieden eine vulnerable Situation, die eine psychogene Triggerung maligner Arrhythmien bewirkte (Fall 1); eine Panikepisoden-?hnliche Erwartungsspannung (Fall 2) sowie eine aversive ?rgerreaktion, die auf dem Boden eines andauernden Zustandes von Hilf- und Ausweglosigkeit (Fall 3) einen besonders potenten sympathiko-exzitatorischen Stimulus darstellt. Dieses Ergebnis deckt sich mit einer Reihe von laborexperimentellen und epidemiologischen Studien, die einen Zusammenhang zwischen psychischer Erregung und der Entstehung von Tachyarrhythmien belegen. Die Berücksichtigung emotional-kognitiver Faktoren bei der Arrhythmogenese k?nnte ein Beitrag bei der Therapie zur Pr?vention des pl?tzlichen Herztodes werden.     

Individual differences in moral judgment competence influence neural correlates of socio-normative judgments

To investigate how individual differences in moral judgmentcompetence are reflected in the human brain, we used event-relatedfunctional magnetic resonance imaging, while 23 participantsmade either socio-normative or grammatical judgments. Participantswith lower moral judgment competence recruited the left ventromedialprefrontal cortex and the left posterior superior temporal sulcusmore than participants with greater competence in this domainwhen identifying social norm violations. Moreover, moral judgmentcompetence scores were inversely correlated with activity inthe right dorsolateral prefrontal cortex (DLPFC) during socio-normativerelative to grammatical judgments. Greater activity in rightDLPFC in participants with lower moral judgment competence indicatesincreased recruitment of rule-based knowledge and its controlledapplication during socio-normative judgments. These data supportcurrent models of the neurocognition of morality according towhich both emotional and cognitive components play an importantrole.     

Notiz

Ohne Zusammenfassung