A recurrent foot ganglion managed with extensor digitorum brevis muscle flap coverage

The case of a 42-year-old woman with a persistent ganglion cyst of the dorsolateral aspect of the foot is presented. After multiple aspirations and 4 attempts at excision, the lesion degenerated into a painful, persistently draining wound with communication to the calcaneocuboid joint. The case was treated with dissection of the lesion to the joint, excision, and coverage of the defect with an extensor digitorum brevis muscle flap. The rationale for this surgical approach and the literature regarding recurrent ganglia are discussed.     

Adaptive equipment use by people with motor neuron disease in Australia: a prospective,observational consecutive cohort study

Purpose: People with motor neuron sisease require adaptive equipment to enhance life quality. This study aimed to examine total and concurrent equipment items prescribed with phenotype consideration.

Methods: A prospective, observational consecutive cohort study was undertaken. Data regarding Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised, phenotype, symptom onset and Functional Independence Measure (inpatients only) was recorded. Equipment utilized was coded by therapist as: speech devices; transfer devices; mobility devices (including power wheelchairs); orthoses; activities of daily living equipment; assisted technology and home modification equipment.

Results: Two hundred and seventy-three people with motor neuron disease participated, mean age 67?years, mean amyotrophic Lateral Sclerosis Functional Rating Scale-Revised score 32, a moderate level of disability. Equipment items per participant ranged from 0 to 20, median 5. The electric lift recliner chair was the most commonly used equipment item, used by 51.2% of the cohort. There was a statistically significant difference in equipment use between flail leg and bulbar (Md 11, 3 items, respectively; p?=?.005), and flail leg and cervical phenotypes (Md 11, 3.5 items respectively; p?=?.009).

Conclusions: People with motor neuron disease have high equipment needs to optimize quality of life. Information regarding phenotype relative to equipment requirement, and most frequently prescribed equipment items can assist health-care providers anticipate equipment needs, burden and intensity for those with motor neuron disease.

• Implications for rehabilitation

• People with motor neuron disease have high concurrent equipment needs.

• Electric recliner lift chairs are the most frequently prescribed equipment item by those with motor neuron disease.

• There is variation in concurrent equipment needs relative to motor neuron disease phenotype.

     

Human epidermal growth factor receptor 2 (HER2) in advanced gastric cancer: where do we stand?

Gastric Cancer - Gastric cancer is one of the most common malignancy worldwide. In unresectable or metastatic disease, the prognosis is poor and in generally less than a year. HER2 expression...     

Improving indoor environmental quality for public health: impediments and policy recommendations

BACKGROUND: People in modern societies spend more than 90% of their time indoors. Hence, indoor environmental quality (IEQ) has a significant impact on public health. In this article we describe health risks associated with indoor environments, illuminate barriers to overcoming these risks, and provide policy recommendations to achieve healthier indoor environments. OBJECTIVES: The weight of evidence suggests that indoor environmental contaminants pose significant public health risks, particularly among children and the poor, and the societal costs of illnesses related to indoor environments are considerable. Despite the evidence of harm to human health, poor indoor environments are generally difficult to regulate and not of sufficient concern to the general public. We discuss several reasons for this lack of concern about IEQ, focusing specifically on home environments. DISCUSSION: Economics plays a large role both in political inaction and individual-level indifference. Because little effort has been made to quantify the value of the societal and individual costs of poor housing quality, as well as the benefits achievable by simple interventions, policymakers lack motivation to act on IEQ. Similarly, individual homeowners lack the incentive to remediate homes, as other problems may be more pressing than home environmental quality. CONCLUSIONS: Although the problem of IEQ involves multiple stakeholders and multiple levels of governance, it is possible to establish economic incentives that would set the wheels in motion for action at all levels to achieve healthy home environments. Also important are education and information dissemination on the public health risks associated with indoor environments. These recommendations are intended for all decision makers who have an influence in developing policy to improve indoor environmental quality.     

Effects of passive smoking on theophylline clearance

Theophylline disposition was examined in seven passive smokers, defined as nonsmokers with long-term exposure to cigarette smoke, and seven age-matched nonsmokers with minimal smoke exposure. Subjects were given an intravenous infusion of aminophylline (6 mg/kg) and blood samples were drawn before and during the 48-hour postinfusion period. Clearance for passive smokers was 6.01 x 10(-2) L/hr.kg and for nonsmokers, clearance was 4.09 x 10(-2) L/hr.kg (p less than 0.025). Terminal elimination half-life for passive smokers was 6.93 hours versus 8.69 hours for nonsmokers (p less than 0.05). The mean residence time for passive smokers was 9.89 hours. For nonsmokers, the mean residence time was 13.11 hours (p less than 0.05). These measurements were statistically different, whereas there was no difference in volume of distribution between the groups, suggesting that passive smokers metabolize theophylline more rapidly than nonsmokers. Plasma and urine cotinine and nicotine concentrations were measured in all subjects. There was a significant difference between the subject groups in plasma (p less than 0.004) and urine (p less than 0.002) cotinine concentrations. Theophylline clearance correlated with both plasma (r = 0.73, p less than 0.01) and urine (r = 0.79, p less than 0.01) cotinine concentrations. Additional studies should be conducted to further define the pharmacokinetic characteristics of passive smokers and to assess the effects of passive smoking on drugs metabolized by the mixed function oxidase system.     

Prenatal diagnosis of herniated Dandy-Walker cysts.

OBJECTIVE: The purpose of this series is to describe the prenatal diagnosis and pregnancy outcome of fetuses affected with Dandy-Walker malformation in which a posterior cyst herniated through a bony defect of the occipital skull, foramen magnum, or both. METHODS: Two- and 3-dimensional sonography were used to examine 2 fetuses with poorly delineated cerebellar structures and a large posterior cystic neck mass. Fetal magnetic resonance imaging (MRI) was added to this evaluation as a complementary diagnostic modality. RESULTS: Three-dimensional sonography helped characterize the precise site of cyst herniation through the occipital skull or foramen magnum. Fetal MRI confirmed the sonographic findings. Neonatal MRI studies identified heterotopic gray matter as evidence of a neuronal migration disorder in both fetuses. The second fetus also had agenesis of the corpus callosum. Retrospective review of the fetal MRI (25.9 weeks' menstrual age) and 3-dimensional sonographic (18.7 weeks' menstrual age) studies confirmed ventricular wall nodularity involving the occipital horns of the second fetus. CONCLUSIONS: The antenatal detection of a large posterior cystic neck mass and a poorly defined or nonvisualized cerebellar vermis suggest Dandy-Walker malformation with a herniated cyst. Three-dimensional sonography and fetal MRI are important adjunctive methods that can be used to evaluate the herniation site and a possible neuronal migrational disorder.     

An interprofessional team simulation exercise about a complex geriatric patient

ABSTRACT

Interprofessional collaboration is an essential skill to optimize the care of older adults with complex problems. We successfully developed and evaluated an interprofessional teamwork simulation exercise for medical, nursing, pharmacy, and social work students. Pharmacy students participated via video conferencing.

Before the simulation, students watched a teamwork video and reviewed the patient case. Following an icebreaker exercise, interdisciplinary faculty facilitated a discussion highlighting effective teamwork strategies. Students then collaborated to develop a discharge plan, followed by a simulated family meeting with a theater student. Interdisciplinary faculty again provided structured debriefing highlighting principles of effective teamwork.

Students self-rated interprofessional practice core competencies were evaluated using a retrospective pre/post survey and analyzed using paired t-tests. We qualitatively examined the use of distance technology and assessed learner’s satisfaction with the project. All core competency categories for all disciplines demonstrated significant improvements in mean scores. Students’ qualitative comments demonstrated positive impact on learning interprofessional core competencies.     

Acute respiratory response of guinea pigs to lipopolysaccharide, lipid A, and monophosphoryl lipid A from Salmonella minnesota

Exposure to endotoxin has been associated with systemic toxicity, including pulmonary disorders such as byssinosis, as well as with beneficial biologic activities such as adjuvanticity and mitogenicity. The purified lipopolysaccharide (LPS) from endotoxin has been employed to investigate structure-activity relationships for various biologic effects. The current study was undertaken to examine the relationship between LPS structure and its ability to cause respiratory toxicity in guinea pigs after inhalation exposure. Animals were exposed to atmospheres containing 0.076 to 2.1 micrograms/m3 Salmonella minnesota LPS (S. minn. LPS), LPS from the mutant S. minn. Re595, S. minn. Re595 lipid A, and monophosphoryl S. minn. Re595 lipid A (S. minn. Re595 MPL). Each of the LPS aerosols caused increased breathing frequency (f), decreased tidal volume (VT), and airflow disturbance when measured 18 h after the 6-h inhalation exposure. The LPS preparations had equivalent toxicity, whereas the lipid A aerosol had slightly reduced toxicity. The MPL preparation did not produce this respiratory toxicity response. The results indicated that absence of the terminal phosphate group from the reducing end of the lipid A disaccharide destroyed its ability to cause the respiratory effect. These results initiate structure-activity studies of defined LPS in the lung and indicate the possibility of chemically treating endotoxins to remove adverse pulmonary effects.     

Concomitant coronary artery disease and its management in patients referred to transcatheter aortic valve implantation: Insights from the POL‐TAVI Registry

• The femoropopliteal (FP) artery is a common site for endovascular interventions.
• S.M.A.R.T.® stent is effective in treating FP lesions with results comparable to other treatment options.
• Without head‐to‐head randomized controlled trials, the ideal treatment strategy for FP lesions remains unknown.