bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mobility of the Proximal Tibio-Fibular Joint. A Roentgen Stereophotogrammetric Analysis on Six Cadaver Specimens
Authors: Soavi Raffaella , Girolami Mauro , Loreti Ivano , Bragonzoni Laura , Monti Carlo , Visani Andrea , Marcacci Maurilio
Published: January 2017

In six cadaver specimens the mobility of the proximal fibula in relation to the tibia was investigated during plantar/dorsiflexion of the ankle, using Roentgen Stereophotogrammetric Analysis (RSA). The role of the ankle joint, and of the calcaneofibular and talofibular ligaments was also evaluated.

The greatest movements were observed along the medio-lateral and anterior-posterior axes, resulting in an anterolateral displacement of the fibula head during dorsiflexion and in a postero-medial displacement during plantarflexion.

This study demonstrated a limited mobility of the proximal tibiofibular joint. Moreover, the ligament cutting and the presence of constraints in the ankle region did not show any effect on the fibular movement.
Implantable Electrical Stimulation in High-Risk Hindfoot Fusions
Authors: Donley Brian G. , Ward Daniel M.
Published: January 2017

The risk of nonunion in both the ankle and subtalar joints has been reported as high as 41% and 16%, respectively. Several factors have been reported to significantly increase the incidence of nonunion: smoking, previous nonunion, osteonecrosis, history of infection, fracture type, and major medical problems. A single surgeon's experience is retrospectively reviewed. Thirteen patients who were identified as high risk for non-union had an implantable electrical stimulator placed at the time of their ankle or hindfoot fusion along with bone grafting. Three ankle, two subtalar, six tibiotalocalcaneal, and two tibiocalcaneal fusions were performed. All 13 patients had a minimum of two major risk factors for non-union. Of the 13 patients, 11 were active smokers and five of 13 had three or more major risk factors. At a minimum of one year follow-up (average, 24.6 months), successful fusion was achieved in 12 of 13 (92%) patients. Pain scores improved from a mean of 8.5 points preoperatively (range, 7 to 10) to a mean of 1.9 points postoperatively (range, 1 to 6), while the preoperative mean modified AOFAS score of 31.2 points (range, 15 to 55) improved to 85.4 points (range, 45 to 100) postoperatively. The improvement was statistically significant at p<0.01. Eleven of 13 patients (85%) ranked their pain as a 1 or 2 out of 10, and achieved a modified AOFAS score of 80 or better. No additional procedures were done to achieve fusion. Four patients developed superficial wound infections requiring local wound care. The subcutaneous battery pack was bothersome to eight of 13 patients, painful to one, and removed in four patients. The results suggest that electrical implantable stimulation may be a useful adjunct to rigid internal fixation and bone grafting for ankle and hindfoot fusions in high-risk patients.
Insertional Achilles Tendinosis: Surgical Treatment Through a Central Tendon Splitting Approach
Authors: McGarvey William C. , Palumbo Robert C. , Baxter Donald E. , Leibman Bryan D.
Published: January 2017

Twenty-two heels in 21 patients treated surgically for a primary diagnosis of insertional Achilles tendinosis were reviewed on the basis of preoperative and postoperative examinations, office records, and a comprehensive questionnaire administered to each subject. Each patient underwent surgical treatment using a midline-posterior skin incision combined with a central tendon splitting approach for debridement, retrocalcaneal bursectomy, and removal of the calcaneal bursal projection as necessary.

The findings at surgery revealed involvement of the middle third of the insertion in 21 of 22 cases with only one patient manifesting isolated lateral involvement. Thirteen of 22 had an associated prominent calcaneal bursal projection and four of 22 a superficially inflamed bursa. Three patients required reinsertion of the tendo Achilles via drill holes and one underwent augmentation with a plantaris tendon.

Operative findings and complications were reported. Eight male and 13 female patients underwent 22 procedures (one case bilaterally) with an average follow-up of 33 months. Preoperative symptoms include presence of symptoms over a range of three months to two years and pain associated with activities of daily living (17 of 22), limitation of regular activities (six of 22), and pain present at rest in six of 22.

Postoperatively, 20 of 22 patients were able to return to work or routine activities by three months; only 13 of 22 were completely pain free. Only 13 of 22 also claimed that they were able to return to unlimited activities. Overall, there was an 82% (18 of 22) satisfaction rate with surgery and 77% (17 of 22) stated they would have the surgery again.
The Acquired Midtarsus Deformity Classification System—Interobserver Reliability and Intraobserver Reproducibility
Authors: Schon Lew C. , Easley Mark E. , Cohen Ilan , Lam Peter W.-C. , Badekas Athanasios , Anderson Claude D.
Published: January 2017

A radiographic classification (Schon's) divides Charcot midtarsus deformities into four types identified by Roman numerals (I to IV), according to the anatomical location of the pathological process, 11 and an objective method of severity staging using radiographic criteria is introduced and tested. A beta stage is assigned if one of the following criteria is met:

a dislocation is present; the lateral talar-first metatarsal angle is ≥ 30°; the lateral calcaneal-fifth metatarsal angle ≥ 0; or the AP talar-first metatarsal angle is > 35°.

An alpha stage can be assigned when all four features are absent. Clinical features useful in assessing and managing these deformities have been associated with the various types and stages. To determine whether the classification system is valid, a study was performed. Two examination booklets and an instructional booklet designed to teach the method were distributed to 75 orthopaedic surgeons at the AOFAS summer meeting to test for intraobserver reproducibility and interobserver reliability. Information about the participants was recorded, and the tests were scored. The highest scores for correct responses were achieved by foot and ankle fellows, followed by orthopaedic residents. Attending orthopaedic surgeons achieved the lowest scores. The most common error was a type I deformity misidentified as a type II. The interobserver reliability for correctly classifying the deformities was 81%, and the intraobserver reproducibility was 97%. We concluded that this classification system, intended to clarify the patterns of acquired midfoot collapse, permits assignment of both anatomic type (I to IV) and degree of severity (alpha-beta) with high reliability and reproducibility. It can therefore be used as a tool for diagnosis, planning treatment, and assessing the prognosis.
CT Analysis of Hindfoot Alignment in Chronic Lateral Ankle Instability
Authors: Van Bergeyk Anthony B. , Van Younger Alastair , Van Carson Brent
Published: January 2017

A prospective case-control study was performed comparing axial and coronal CT scan images of 11 patients (14 ankles) with chronic lateral instability and 12 controls. Scans were performed in a standardized fashion to simulate weight-bearing. Nine measurements to evaluate the alignment of the hindfoot and forefoot were made on two occasions by two observers. The blinded images were read in order of assigned random number. The angle between the calcaneus and the vertical plane showed a statistically significant difference between patients (6.4 +/- 4° varus from vertical) and controls (2.7 +/- 5°) using unpaired ANOVA (p < 0.01). Intra-observer (R2 = 0.49 +/-0.19) and interobserver (R2 = 0. 71 +/- 0.13) variation showed moderate reliability across all measurements. This study demonstrates a method to evaluate hindfoot varus on CT scan. Many factors have been studied (e.g., proprioception) as the cause for recurrent instability, and this is the first time, to our knowledge, that an anatomic cause has been demonstrated. Although calcaneal osteotomy is clearly not indicated routinely, it may have a role in correcting extreme varus, which may contribute to failed ligament reconstruction in patients with ankle instability.
Arch Height and Lower Limb Pain: An Adult Civilian Study
Authors: Hogan Molly T. , Staheli Lynn T.
Published: January 2017

Flexible flatfeet in children are still treated with orthotics and operative procedures by some physicians who believe such treatment will prevent disability in adult life. Opponents of treatment cite military studies that show flexible flatfeet are not a source of disability in soldiers. Because no study of adult civilians relating arch configuration and pain have been reported, this study was undertaken.

Ninety-nine adult male and female physically active grocery-store employees were studied. Half-weight-bearing footprints were made, and leg and foot pain questionnaires were scored for each subject. No relationship was found between arch configuration and pain scores. This study suggests that in the civilian population flexible flatfeet are not a source of disability. This study is consistent with previous studies and provides additional evidence against the practice of treating flexible flatfeet in children.
Medial Eminence Thickness with and without Hallux Valgus
Authors: Thordarson David B. , Krewer Philip
Published: January 2017

The purpose of this study was to determine if hypertrophy of the medial eminence occurs in patients with hallux valgus. Thirty-three patients (50 consecutive feet) who underwent surgical correction for hallux valgus were evaluated. They had preoperative and postoperative radiographs. The hallux valgus angle, intermetatarsal angle and size of the medial eminence were recorded. The same measurements were then obtained from the radiographs of 50 randomly selected, age-matched controls with a hallux valgus angle less than 15° and intermetatarsal less than 9°. The average width of the medial eminence was 4.4 mm in the hallux valgus group and 4.1 mm in the control group. In most patients, hypertrophy of the medial eminence is not a component of the pathology.
The Accessory Flexor Digitorum Longus as a Cause of Flexor Hallucis Syndrome
Authors: Eberle Charles F. , Moran Brion , Gleason Theodore
Published: January 2017

The Flexor Hallucis Syndrome has been associated with ballet and sports activities. It has been thought to represent over use with attendant tenosynovitis of the tendon in the fibro-osseous tunnel extending from the ankle to the midfoot. We report a patient with an accessory flexor digitorum longus who presented with classical clinical features of the syndrome. The patient's disabling symptoms persisted despite a year and a half of nonoperative treatment. They were finally relieved when the accessory muscle was excised. In addition to the previously described clinical features of the Flexor Hallucis Syndrome, the physical exam included abnormal fullness between the Achilles tendon and the tibia. When the ankle was held in dorsiflexion, there was limited dorsiflexion of the lateral toes, which were tethered by the “cork-in-a-bottle” effect of the distal muscle mass of the accessory flexor digitorum longus muscle at the flexor retinaculum and fibro-osseous canal of the flexor hallucis longus. The MRI examination confirmed the presence of an abnormal muscle mass extending distal to the ankle joint with the foot in neutral. The study also demonstrated fluid in the ankle joint and fibro-osseous canal of the flexor hallucis, and marrow edema within the body of the talus consistent with chronic inflammation. Follow-up MRI six months after excision of the muscle revealed some scar formation at the site of the previously excised muscle and complete resolution of the joint effusion, fluid in the tunnel of the flexor hallucis, and marrow edema.
Imaging of Frostbite Injury by Technetium-99m-Sestamibi Scintigraphy: A Case Report
Authors: Aygit A. Cemal , Sankaya Ali
Published: January 2017

The appearance of superficial tissue is often an unreliable indicator of deep-tissue viability in cases of frostbite. We present a 34-year-old black man who was brought to the emergency department at fourth post-injury day with frostbite injury involving both lower extremities after prolonged exposure to subzero temperatures. In our previous experimental study, 99mTc sestamibi scintigraphy has been employed for evaluating frostbite injuries in rabbit hindlegs. In the case presented, 99mTc sestamibi scintigraphy, as a new diagnostic tool, was performed for detection of skeletal muscle perfusion on the fourth post-injury day.

The scintigraphic images show diffusely reduced uptake in soft tissues of both calves and feet. It was thought that this hypoperfusion was due to viable but ischemic tissue. Five days after medical therapy, 99mTc sestamibi scan showed prominently increased uptake in both calves and feet and skin necrosis was observed. Debridement of necrotic skin and subcutaneous tissue was performed, and split-thickness skin graft was applied for coverage of the skin defect. Healing was good 15 days after grafting. We think 99mTc sestamibi scan can be used for assessment of soft-tissue perfusion and evaluation of treatment in frostbite injury.
Bilateral Calcaneal Intraosseous Lipoma: A Case Report
Authors: Yildiz Hüseyin Yusuf , Altinok Deniz , Saglik Yener
Published: January 2017

Intraosseous lipoma is a rare benign primary lesion of bone. Approximately 180 cases have been reported to date. In the literature, we have been able to find only three patients with bilateral calcaneal involvement. We present a 34-year-old woman who was diagnosed with intra-osseous lipoma in both calcanei.
CXCL12/CXCR4/CXCR7 Chemokine Axis in the Central Nervous System: Therapeutic Targets for Remyelination in Demyelinating Diseases
Authors: Chu Tianci , Shields Lisa B. E. , Zhang Yi Ping , Feng Shi-Qing , Shields Christopher B. , Cai Jun
Published: January 2017

The chemokine CXCL12 plays a vital role in regulating the development of the central nervous system (CNS) by binding to its receptors CXCR4 and CXCR7. Recent studies reported that the CXCL12/CXCR4/CXCR7 axis regulates both embryonic and adult oligodendrocyte precursor cells (OPCs) in their proliferation, migration, and differentiation. The changes in the expression and distribution of CXCL12 and its receptors are tightly associated with the pathological process of demyelination in multiple sclerosis (MS), suggesting that modulating the CXCL12/CXCR4/CXCR7 axis may benefit myelin repair by enhancing OPC recruitment and differentiation. This review aims to integrate the current findings of the CXCL12/CXCR4/CXCR7 signaling pathway in the CNS and to highlight its role in oligodendrocyte development and demyelinating diseases. Furthermore, this review provides potential therapeutic strategies for myelin repair by analyzing the relevance between the pathological changes and the regulatory roles of CXCL12/CXCR4/CXCR7 during MS.
Remote Ischemic Conditioning in Cardiovascular Surgery
Authors: Heusch Gerd
Published: January 2017

The existing clinical studies on remote ischemic preconditioning in patients undergoing cardiovascular surgery are critically reviewed, with a focus on infarct size reduction and clinical outcome as end points. Confounders, notably the use of propofol anesthesia are identified. The need for better designed trials with a more targeted approach is emphasized.
Vibro-acoustic coupling in composite plate-cavity systems
Authors: Sarıgül A Saide , Karagözlü Erkan
Published: January 2017

Composite materials are extensively utilized today as strategic products. Although this widespread use, their vibro-acoustics characteristics have not been examined extensively. Specifically, the interactive coupling between the vibration and acoustics of composite plate- cavity systems is an untapped field. In this paper, the results of a modal structural-acoustic coupling analysis for plates with different composite parameters are presented. Natural frequencies of the coupled systems are tabulated. The effects of material, ply angle and number of layers on the coupled vibro-acoustic characteristics of composite plate-cavity systems have been examined and compared with the behaviour of isotropic plate systems.
A Cross-Country Analysis of Fixed Broadband Deployment: Examination of Adoption Factors and Network Effect
Authors: Lee Sangwon , Brown Justin S. , Lee Seonmi
Published: January 2017

Broadband infrastructure is a key component of the knowledge economy. Employing a secondary data set, this study examines adoption factors of fixed broadband among OECD countries. The results suggest platform competition, income, and education positively influence fixed broadband diffusion. Light form of Local Loop Unbundling (LLU) was positively associated with high levels of fixed broadband diffusion. Results show that it may be beneficial for countries to pursue light-touch LLU regulation like bitstream access instead of strong regulation. This study also suggests that network effects and the effects of platform competition coexist in many OECD countries.
Young Adults' Reasons behind Avoidances of Daily Print Newspapers and Their Ideas for Change
Authors: Zerba Amy
Published: January 2017

Focus groups in three cities were conducted with young adults (ages 18–29) to understand why they don't read daily print newspapers. The study examined news media avoidances, like “inconvenience” and “lack of time,” to uncover underlying meanings. Results showed prominent nonuse reasons have dimensions. Participants also suggested ways newspapers could improve. Participants were studied as two age groups, 18–24 and 25–29. Small group differences did emerge. The older group wanted less negative news, while the younger group justified it; the younger age group was more skeptical of the news and mentioned needing greater effort to understand it.
Exploring Languages Preservation in Kham Tibet, Learning From “Discourse in the Novel,” and Writing a Dialogical/Bakhtinian Ethnography
Authors: Kang Dongjing , Rawlins William K.
Published: January 2017

This essay pursues three interrelated and reflexively challenging objectives. First, we celebrate Mikhail Bakhtin’s “Discourse in the Novel” as constituting a singular primer for writing and accomplishing dialogical ethnography. Second, we exemplify and dramatize its lessons by relating stories and practices of the first author’s 4-year ongoing field study and involvement with languages preservation, community enhancement, and social transformation in Kham Tibet. Finally, we accomplish these first two purposes in a self-consciously reflexive manner seeking to embody Bakhtin’s suggestions even as we describe them. We close with a tentative description of languages and voices we notice in writing this essay.
Travels With My Father
Authors: Claiborne Lise
Published: January 2017

Barad’s diffractive methodology was used to explore one man’s encounter with Parkinson’s disease after long exposure to pesticides in home maintenance. The study moved from a realist account of relevant studies in toxicology, entomology, and neurology toward an onto-ethico-epistemological enquiry that asked how humans and insects live and work within the shared mattering of minerals, water, and time. Constructed memories of my father’s later life were explored within masculine discourses about protection of the family from invading insects and an intra-active reconsideration of the contradictions involved in the use of poison as both care and harm. New materialist theorizing took the focus from an exploration of the difference experienced by one fragile body toward a larger engagement with material and discursive forces, ending with questions about U.S. modernism and the tenaciousness of human subjectivities in a time of changing climate and movement of species around the globe.
Listeria monocytogenes behaviour and quality attributes during sausage storage affected by sodium nitrite, sodium lactate and thyme essential oil
Authors: Blanco-Lizarazo Carla María , Betancourt-Cortés Rubén , Lombana Angélica , Carrillo-Castro Katerine , Sotelo-Díaz Indira
Published: January 2017

The effects of the addition of nitrite at 200 ppm (N), sodium lactate 1.5% (L) and thyme essential oil at 100 ppm (T1) on Listeria monocytogenes behaviour and ATPase activity inhibition were evaluated, as well as lipid oxidation through the quantification of malonaldehydes, in sausage stored at 8 ℃ for 41 days and at 30 ℃ for 14 days. The changes in the colour profile were performed during storage time at 8 ℃. Quantitative descriptive sensory analyses were performed after two days at 4 ℃. At 8 ℃, the treatments with the highest inhibition on L. monocytogenes were L and N, without significant differences. In turn, at 30 ℃, the bacterium was most inhibited with treatment L, followed by T1 and N, without significant differences. A 44.1% and 19% inhibition of ATPase activity was detected in L and T1 treatments, respectively. At 8 ℃ and 30 ℃, malonaldehydes content was not different between the treatments. N presented the highest values of a* and concentration of metmyoglobin after 41 days at 8 ℃. The panel detected differences between T1 and N for the aroma in the descriptors spices and herbal.
The Coexistence of Psoriasis and Vitiligo: A review
Authors: Sawchuk Michael , Spano Frank , Loo Wei Jing , Guenther Lyn
Published: January 2017

Background:

Psoriasis and vitiligo are both autoimmune diseases with an increased incidence noted in genetic relatives. They share similar trigger factors and have been observed to coexist in individuals.

Objective:

The purpose was to review the literature on the coexistence of psoriasis and vitiligo and to determine if there is a higher than expected prevalence of psoriasis in patients with vitiligo and vice versa.

Methods:

A literature review was conducted using Medline, EMBASE, and the Cochrane Library from 1968 to 2010. All articles that included reports of individuals with both psoriasis and vitiligo in the English language were documented.

Results:

We identified 338 articles, among which 35 case reports and 7 case series were mentioned. For each case series, the prevalence of psoriasis in patients with vitiligo, or vice versa, falls within the prevalence range of the background population on which the study was based.

Conclusion:

An increase in the expected prevalence of psoriasis in individuals with vitiligo, or vice versa, was not found in our study, suggesting that the coexistence of the two diseases appears to be due to chance alone. Large epidemiologic studies are required to address with certainty whether psoriasis is more common in individuals with vitiligo and vice versa.

Renseignements de base:

Le psoriasis et le vitiligo sont deux affections auto-immunes qui ont une incidence accrue observée chez les membres de la famille apparentée. Ils partagent des facteurs déclencheurs similaires, et des études ont démontré leur coexistence chez les personnes.

Objectif:

Le but était de faire une analyse documentaire sur la coexistence du psoriasis et du vitiligo et de déterminer s'il y a une prévalence plus élevée que prévu du psoriasis chez les patients atteints de vitiligo et vice versa.

Méthodes:

Une analyse documentaire a été effectuée en utilisant Medline, EMBASE, et la Cochrane Library de 1968 à 2010. Tous les articles comportant des rapports sur des personnes souffrant à la fois de psoriasis et de vitiligo rédigés en anglais ont été documentés.

Résultats:

Nous avons trouvé 338 articles, parmi lesquels 35 exposés de cas et 7 séries de cas ont été mentionnés. Pour chaque série de cas, la prévalence du psoriasis chez les patients atteints de vitiligo, ou vice versa, s'inscrit dans la fourchette de prévalence de la population de base qui a fait l'objet de l'étude.

Conclusion:

Notre étude n'a pas démontré une augmentation de la prévalence de psoriasis attendue chez les personnes atteintes de vitiligo, ou vice versa, ce qui suggère que la coexistence des deux affections semble être due au seul hasard. D'importantes études épidémiologiques sont nécessaires pour démontrer avec certitude que le psoriasis est plus fréquent chez les personnes atteintes de vitiligo et vice versa.
Agreement between Dermatologists and Primary Care Practitioners in the Diagnosis of Malignant Melanoma: Review of the Literature
Authors: Corbo Michael D. , Wismer Judy
Published: January 2017

Background:

The incidence of melanoma continues to rise in the developed world. It is therefore essential for primary care practitioners (PCPs) to be able to discriminate between malignant and benign cutaneous findings, as most patients present to PCPs first for examination of suspicious lesions.

Objective:

To compare dermatologists and PCPs in the diagnosis of malignant melanoma.

Methods:

Prospective studies published from January 1950 to August 2010 in MEDLINE, EMBASE, CINAHL, and CancerLit databases were examined. Relevant medical search terms, discussed amongst the authors, were entered into the databases. Only articles comparing dermatologists and PCPs in the diagnosis of malignant melanoma were selected.

Results:

Dermatologists were reported as having sensitivities, specificities, and diagnostic accuracies ranging from 0.74 to 1.00, 0.56 to 0.95, and 0.85 to 0.89, respectively. PCPs had sensitivities, specificities, and diagnostic accuracies ranging from 0.25 to 0.88, 0.26 to 0.71, and 0.49 to 0.80, respectively.

Conclusions:

PCPs should receive more training to improve their ability in the diagnosis of malignant melanoma.

Contexte:

La fréquence du mélanome est en hausse continue dans les pays développés. Dans ce contexte, il est essentiel que les médecins de premier recours (MPR) puissent distinguer les lésions cutanées malignes des lésions cutanées bénignes, étant donné que la plupart des patients consultent d'abord un MPR pour l'examen des lésions douteuses.

Objectif:

L'étude visait à comparer les dermatologues et les MPR dans le diagnostic du mélanome malin.

Méthode:

Nous avons procédé à un examen d'études prospectives, publiées de janvier 1950 à août 2010, dans les bases de données MEDLINE, EMBASE, CINAHL, et CancerLit. Les termes d'interrogation médicaux pertinents, ayant fait l'objet de discussion parmi les auteurs, ont été inscrits dans les bases de données. Seuls les articles dans lesquels il y avait une comparaison entre dermatologues et MPR dans le diagnostic du mélanome malin ont été sélectionnés.

Résultats:

La sensibilité, la spécificité, et la précision du diagnostic parmi les dermatologues variaient de 0.74 à 1.00, de 0.56 à 0.95, et de 0.85 à 0.89, respectivement, tandis que la sensibilité, la spécificité, et la précision du diagnostic parmi les MPR variaient 0.25 à 0.88, de 0.26 à 0.71, et de 0.49 à 0.80, respectivement.

Conclusion:

Les MPR devraient recevoir plus de formation afin d'améliorer leur capacité de diagnostic du mélanome malin.
Occurrence of Squamous Cell Carcinoma in an Area of Lichen Simplex Chronicus: Case Report and Pathogenetic Hypothesis
Authors: Tiengo Cesare , Deluca Jenny , Belloni-Fortina Anna , Salmaso Roberto , Galifi Flavia , Alaibac Mauro
Published: January 2017

Background:

Lichen simplex chronicus is a common skin disorder characterized by circumscribed, lichenified, pruritic plaque secondary to local repetitive trauma, notably rubbing and scratching.

Objective:

We describe a case of a squamous cell carcinoma arising in a patient with a long-lasting history of lichen simplex chronicus and discuss the potential role of the microenvironment in predisposing the malignant transformation.

Conclusion:

Here we propose a hypothesis in which rubbing and scratching contribute to an excess of inflammatory mediators, which in turn may lead to alterations in the processes of keratinocyte proliferation and differentiation.

Renseignements de base:

Le lichen simplex chronique est une affection cutanée courante caractérisée par une plaque pruritique lichénifiée circonscrite consécutive à des traumatismes locaux répétés, notamment le frottement et le grattage.

Objectif:

Nous décrivons un cas de carcinome squameux chez un patient présentant depuis longtemps des antécédents de lichen simplex chronique, et nous discutons du rôle potentiel du micro-environnement dans la prédisposition de la transformation maligne.

Conclusion:

Nous proposons ici une hypothèse selon laquelle le frottement et le grattage contribuent à un excès de médiateurs inflammatoires, lesquels peuvent à leur tour venir modifier les processus de prolifération et de différenciation des kératinocytes.
Endogenous Ochronosis with a Fatal Outcome
Authors: Zaraa Inès , Labbène Imen , Trojjet Sondes , Mrabet Dalila , Meddeb Nihel , Chelly Ines , Haouet Slim , Mokni Mourad , Sellami Slaheddine , Osman Amel Ben
Published: January 2017

Background:

Endogenous ochronosis (EO) is an autosomal recessive inherited disorder where there is incomplete oxidation of tyrosine and phenylalanine due to a lack of the enzyme homogentisic acid oxidase.

Objective:

We report a singular observation of EO with a fatal outcome.

Case Report:

We report the case of a 46-year-old man born to consanguineous parents with a medical history of recurrent renal colic and chronic nonspecific arthropathy. On clinical examination, slate blue pigmentation was seen on the cheeks, forehead, and nose, as well as blue-gray patches on all fingernails and bluish discoloration of the gums. Familial investigation revealed that his sister had similar pigmentation on the ears, hands, and fingernails. Histologic examination of a biopsy specimen from a pigmented lesion showed a dermal deposit of an acellular, eosinophilic material without cell reaction. Based on the clinical and histopathologic data, combined with the family medical history, our patient was considered to have EO with mucocutaneous, articular, and renal involvement. Unfortunately, the diagnosis was late because our patient died a few months later of terminal renal failure.

Conclusion:

Skin signs are the hallmarks of EO and must alert the clinician to look for involvement of vital organs.

Renseignements de base:

L'ochronose endogène (OE) est une affection héréditaire récessive autosomique où il se produit une oxydation incomplète de la tyrosine et de la phénylalanine en raison d'un manque d'oxydase de l'acide homogentisique.

Objectif:

Nous présentons une observation singulière d'OE dont l'issue a été fatale.

Rapport de cas:

Nous exposons le cas d'un homme de 46 ans né de parents consanguins ayant des antécédents médicaux de coliques néphrétiques récurrentes et une arthropathie chronique non spécifique. À l'examen clinique, nous avons observé une pigmentation bleu ardoise au niveau des joues, du front, et du nez, ainsi que des plaques bleu gris sur tous les ongles de doigts et une décoloration bleuâtre des gencives. Une étude des antécédents familiaux a révélé que sa sœur présentait une pigmentation semblable au niveau des oreilles, des mains, et des ongles de doigts. L'examen histologique de l'échantillon de la biopsie pratiquée sur une lésion pigmentée a montré un dépôt cutané de matériel éosinophile acellulaire sans réaction cellulaire. Selon les données cliniques et histopathologiques, combinées aux antécédents médicaux familiaux, notre patient présentait une OE avec une atteinte rénale, articulaire, et muco-cutanée. Malheureusement, le diagnostic a été tardif puisque notre patient est décédé quelques mois plus tard d'insuffisance rénale terminale.

Conclusion:

Les signes cutanés constituent les caractéristiques de l'OE et ceux-ci doivent alerter le clinicien de manière à ce qu'il cherche la contribution des organes vitaux.
Effect of oil starvation on the surface dimple in elastohydrodynamic lubrication contact under opposite sliding conditions
Authors: Meng Xianghua , Wang Jing , Zhang Binbin , Zou Qian
Published: January 2017

Optical interferometry experiments were performed to investigate the dimple phenomena in starved elastohydrodynamic lubrication of point contacts under opposite sliding condition by using a high viscosity polybutene (PB) lubricant. The effects of the bilateral starvation, left starvation, and right starvation on the variation of the oil film under a high slide-to-roll ratio were investigated. It was found that oil starvation could generate a starved constriction, which would make the shape of the oil film resemble the one in pure-rolling or rolling-sliding contact. However, the film thickness at the starved constriction is much lower. In addition, the influence of the applied load on the variation of the surface dimple in fully flooded and starved conditions was explored. It was found that the effect of oil starvation depended on the way the net mass flow through the contact zone. When the net mass flow was from left to right, a major constriction was formed on the right side, and vice versa. When symmetrically increasing the degree of oil starvation, the classical big dimple shrunk and became centralized before eventually disappearing and the contact approximated the nominally flat state of a heavily starved or almost dry contact.
Are Women More Ready to Consult than Men? Gender Differences in Family Practitioner Consultation for Common Chronic Conditions
Authors: Hunt Kate , Ford Graeme , Harkins Leigh , Wyke Sally
Published: January 2017

Background:

When consultations for all reasons are combined, women are seen to consult their general practitioners more than men through most of adult life. It is, therefore, often assumed that women are more likely to consult for every condition.

Objectives:

To examine whether women report being more likely to consult a general practitioner than men when taking account of the underlying condition and various aspects of the experience of the condition consulted for.

Methods:

Home-based nurse-interviews with 852 people in early middle age (39 years) and 858 in late middle age (58 years) sampled from the general population in the West of Scotland. Detailed information about current chronic conditions included general practitioner consultation and reported experience of pain frequency, pain severity, limitation to normal activities and restricted activity in the previous four weeks.

Results:

Women were no more likely than men to consult a general practitioner in the previous year when experiencing the five most common groups of conditions; in addition, women were no more likely than men to consult at a given level of severity for a given condition type, except in the case of one aspect of reported experience of mental health problems.

Conclusions:

The results argue against the most widely accepted explanation for gender differences in consulting, namely, that women are simply more likely to consult a general practitioner than men irrespective of underlying morbidity. Reasons for the higher rates of women consulting observed in general practice-based studies are discussed in relation to these data.
Social Conditions and Paediatric Day Case Tonsillectomy
Authors: Drake-Lee Adrian , Harris Stuart
Published: January 2017

Objective:

To develop a simple method for assessing the proportion of children referred to hospital for tonsillectomy in different areas likely to be suitable for day case treatment based on their medical and social characteristics.

Methods:

Four patient suitability criteria were selected based on previous experience of successful day case surgery and a literature review of the prevalence of contraindications and postoperative complications, as follows: medical contraindications (at least American Society of Anesthetists grade ASA2 to be eligible); home circumstances (no telephone, no car and single parent households were ineligible); distance from the hospital (more than 10 miles resulted in ineligibility); and likelihood of postoperative complications. Data relating to the social criteria were collected prospectively from 500 children under 12 years of age reviewed in the outpatient department and under the care of one of the authors. In addition, the electoral ward UPA8 (Jarman 8) deprivation score relevant to each child was recorded and the sample was divided into quintiles according to mean UPA8 scores. In each quintile, the percentage of children with the appropriate social criteria for day case tonsillectomy was calculated. The relationship between deprivation score and social criteria for day case tonsillectomy was determined using logistic regression.

Results:

The proportion of children deemed socially suitable for day surgery fell continuously from 95% in the least deprived quintile to 55% in the most deprived group (proportion passing the social criteria for suitability= − 1.5035+0.0298UPA8). Using these findings and those from the literature review on the nature and prevalence of contraindications and postoperative complications, a simple formula for realistic day case tonsillectomy targets was specified as A × B × C × D × 100%, where A is the proportion of children with no additional medical problems, B is the proportion passing the social suitability criteria, C is the proportion living within 10 miles and D is the proportion with no postoperative complications. Values for A and D would be derived from local audits.

Conclusions:

The formula can be used by purchasers and hospital managers to set differential day case targets for hospitals related to the characteristics of their patients referred for tonsillectomy. In principle, a similar approach could be applicable to other procedures and other age groups.
Designing Evaluations of Interventions to Change Professional Practice
Authors: Mason James , Wood John , Freemantle Nick
Published: January 2017

The design and interpretation of experimental studies to examine the effectiveness and efficiency of implementation strategies intended to change professional practice are gaining increasing attention. It has been argued that variations of the simple randomised design are most appropriate in this setting. The principles of block designs and their applicability in this field are reviewed critically, as are the choice of outcomes and approaches to economic analysis. We conclude that more complex designs are not superior per se, and that the design, choice of implementation method and topic, and analysis of such experiments should reflect the circumstances of the study.
International Comparisons of Health Care Expenditures: What We Know and What We Do not Know
Authors: Kanavos Panos , Mossialos Elias
Published: January 2017

International comparisons of health care expenditures and their determinants have attracted considerable attention since the early 1960s and have since been used widely to compare countries. The impetus for this has been two-fold: firstly, to assess the macroeconomic efficiency of health systems by determining whether different methods of financing and delivering health care have contributed to the control of overall spending levels; and, secondly, to investigate the determinants of the level of health care expenditure. Empirical research has suggested that there is a causal and statistically significant relationship between growth in health spending and growth in gross domestic product (GDP), and that an increase in the latter brings about a proportionately larger increase in the former. This relationship holds even when other potential determinants, such as urbanisation and age structure of the population, are included in the analysis, leading to the conclusion that health care is a luxury good. This paper examines the extent to which this finding is valid from a methodological perspective and how far it assists policy analysis. We argue that there are significant problems in the measurement of health spending and GDP, discuss the methodological problems in the analysis and suggest that the observed relationship between GDP and health spending is unhelpful and almost certainly misleading for health policy development.
Information Issues in Telemedicine Systems
Authors: McClelland I , Adamson K , Black N D
Published: January 2017

This paper examines the use of the Integrated Services Digital Network (ISDN) for telemedicine from the computer scientist's point of view. As increased bandwidth becomes available at reasonable cost, it becomes possible to employ graphical user interfaces in telemedicine systems. This means that human-computer interaction (HCI) techniques can be applied to the interface design. This paper describes some of these as applied to telemedicine by other authors. HCI techniques can be considered to be part of the development process of telemedicine systems. An integrated, multimedia-based telemedicine system which emulated the concept of a hospital information system would have many benefits, such as a consistent user interface with appropriate clinical metaphors, integrated patient records with facilities to store graphical information, and remote access. Telemedicine has much to offer in terms of providing higher standards of patient care through improved response times by clinicians who have the required information immediately available. The patient also benefits from convenience factors, such as being able to consult locally a remote specialist.
A Pilot Study of the Physician Acceptance of Tele-Oncology
Authors: Allen Ace , Hayes Jeanne , Sadasivan Raj , Williamson Stephen K , Wittman Connie
Published: January 2017

During the winter of 1993, medical oncologists from an urban, university-based hospital provided oncology care to rural patients using interactive video clinics (tele-oncology). In order to assess physician satisfaction with this form of outreach, surveys were performed after the video encounters, as well as after a limited number of subsequent clinical encounters on site. Various aspects of satisfaction were evaluated. Although the sample was small (a total of 41 clinical encounters and 3 oncologists), the results suggested that there was a reasonable level of physician satisfaction with, and confidence in, the use of video to replace some on-site oncology consultations. A definitive study of tele-oncology for providing care to rural cancer patients therefore appears to be warranted.
Fetal Telemedicine: Interactive Transfer of Realtime Ultrasound and Video via ISDN for Remote Consultation
Authors: Fisk Nicholas M , Bower Sarah , Sepulveda Waldo , Garner Paul , Cameron Keith , Matthews Mike , Ridley David , Drysdale Karen , Wootton Richard
Published: January 2017

Current referral practice for ultrasonically detected fetal abnormalities contributes to parental anxiety, inconvenience to patients, diagnostic inaccuracy, and general service inefficiency. To determine whether telemedicine would reduce these disadvantages, we established a 30-channel ISDN link between a district general hospital on an island and a subspecialty referral centre approximately 120 km away on mainland Britain. Live ultrasound images of the fetus were transmitted in realtime from a commercial scanner in the hospital using a total data transfer rate of 2 Mbit/s. After decompression at the receiving end, there was almost no perceptible loss of picture quality or frame rate. This report describes the technical aspects of the link and our preliminary experience with it. In the first two months of its operation, the link worked well and the consultants who used it found themselves confidently making diagnoses and carrying out counselling over it. If confirmed, the success of this technology has implications for future referral practice in fetal medicine.
Development of a Dermatological Image Atlas with Worldwide Access for the Continuing Education of Physicians
Authors: Bittorf A , Krejci-Papa N C , Diepgen T L
Published: January 2017

We constructed a dermatological image database as a telemedicine tool for clinical, histopathological and scientific use. The database contained about 1300 clinical images from the 40,000 slides in our archive, to provide a general overview of dermatological diseases and to cover basic student education. Some of the images were made available on the Internet through the World Wide Web system in the middle of 1994. This paper describes the architecture and components of the image database, which was designed for international access and submission of data. It allowed combined searches according to diagnosis, location and appearance of skin lesions, as well as on-screen visualization of the resulting images.
A Survey of Telemedicine in Italy
Authors: Pisanelli Domenico M , Ricci Fabrizio L , Maceratini Riccardo
Published: January 2017

Italy has a tradition of experimental telemedicine which dates back to the early 1970s. However, despite promising experience, widespread diffusion of telemedicine services has not occurred. The Ministry of Research recognized the potential of telemedicine for improving the quality of health care and reducing costs, and has launched a national plan for financing research and training. The plan is expected to have a major impact on the organization of telemedicine research in Italy. In this paper we describe the current situation, outline the structure of the national plan, and survey various applications in different fields, such as teleconsulting, teleradiology and telemonitoring.
A Comparison of Personal Response Services in Canada and the UK
Authors: Fisk M J
Published: January 2017

Personal response services operating over public telephone networks are now widespread in Western Europe and North America. They serve the needs of a million people in the UK and a further two to three million elsewhere. While most clients are elderly, the scope of such services is extending to people with support needs of all ages, especially where there are medical risks or a likelihood of falls. Such services are, therefore, on a convergent course with those concerned with telemedicine. A study of two personal response services was carried out, one based in Ottawa (Canada) and the other in Oldham (UK). The parallels and contrasts were examined through a survey involving personal interviews with samples of clients. Thirty-eight valid personal interviews were completed, 20 in Ottawa and 18 in Oldham, representing 14% and 53% respectively of all service clients in the survey areas. It is concluded that services established within the health sector (such as many in Canada) are better placed to accommodate change. Convergence with telemedicine will, as a result, be facilitated. In the UK, health authorities and trusts are likely to develop their own telemedicine services in competition with current providers of personal response services, thus delaying convergence.
The Personal Telemedicine System. A New Tool for the Delivery of Health Care
Authors: Mahmud Khalid , Lenz Jacalyn
Published: January 2017

An inexpensive home telemedicine system has been developed, comprising a personal telemedicine unit in the patient's home connected by ordinary telephone lines to a central nursing station. Using this system a nurse or other health-care professional at the central station was able to make a ‘video visit’ to the patient's home. In a preliminary trial, patients were referred by the patient's physician or by a home-care nurse. All 12 patients learned to use the personal telemedicine unit easily and effectively, and there were no complications related to its use. A significant finding was a reduction in the number of home-care visits in seven of the 12 patients (58%). Telecare using the personal telemedicine system was significantly cheaper than care delivered by conventional routes. The average charge was about $15 for a video visit by a nurse, compared with about $90 for a real visit.