bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Melanoma Following Heart Transplantation: A Cautionary Tale
Authors: Nandi A , Groves AR
Published: February 2017

A Nandi, AR Groves. Malignant melanoma following heart transplantation: A cautionary tale. Can J Plast Surg 1994;2(4): 173-174. The incidence of neoplasia in patients on immunosuppression after organ transplantation is 100 times greater than that of the general population. Skin tumours and malignant lymphomas are most common. Such tumours are more aggressive than their counterparts in the general population. A higher incidence may be expected in patients receiving heart transplants since they receive the most vigorous immunosuppressive regimes. A case of malignant melanoma developing five years after cardiac transplantation is reported. The need for increased vigilance towards detection of skin cancers in this risk group is highlighted.
The Appearance of the Median Nerve During Carpal Tunnel Release: Reliability of the Surgeon'S Grading of the Degree of Compression
Authors: Mccabe Steven J
Published: February 2017

SJ McCabe. The appearance of the median nerve during carpal tunnel release: Reliability of the surgeon's grading of the degree of compression. Can J Plast Surg 1994;2(4): 169-170. The reliability of intraoperative grading of the degree of compression of the median nerve during carpal tunnel release has never been tested, even though the appearance of the median nerve at the time of release may contain valuable information regarding the degree of compression. This study used a survey design with high-quality colour photographs of the median nerve at the time of carpal tunnel release to test the reliability of 30 surgeons grading the degree of compression. An important degree of disagreement was found in 11 % of the scores. The calculated reliability of 0.68, while not high enough to make individual treatment decisions based on the appearance of the nerve, is high enough to group patients for the purposes of clinical research.
Anatomical Variation in the Innervation of the Little Finger: A Case Report
Authors: Nelluri Pramod K , Thoma Achilleas
Published: February 2017

The anatomy of peripheral nerves and innervation pattern in the upper extremity has been studied extensively by various authors over the decades. Anomalies and normal variations of all three major nerves have been described in the sensory patterns on both the palmar and dorsal aspect of the hand. This is a case report of a 29-year-old male who presented with a hypothenar mass. On exploration, he was found to have an abnormal communicating branch between the palmar ulnar digital nerve to the little finger and the dorsal branch of the ulnar nerve. This anomaly has not previously been described in the literature.
V-Excision Modification for Direct Necklift
Authors: Hallock Geoffrey G
Published: February 2017

The occasional patient who desires solely aesthetic correction of a neck deformity, but refuses to undergo a classical rhytidectomy, might be a candidate for direct neck skin excision. Eight such patients underwent a V-excision modification with Z-plasty for direct necklift with reasonable results achieved in six (75%). All complications (25%) including hypertrophic scarring and vertical neck contracture occurred in females. All scars, however inconspicuous, were still apparent upon close inspection. Appropriate awareness of these sequelae must be acceptable to any candidate before embarking on this unconventional approach to improvement of neck contour.
Endothelialization after arterial and venous micro-anastomosis
Authors: Harris Patrick G , Chase Sharon , Hong Bang Kao , Loftus Jon B , Mosher John F
Published: February 2017

Knowledge of the initial time required to repair the endothelial surface of small vessels after microsurgical vascular anastomosis of veins and arteries is required to determine the preferable duration of antiplatelet prophylaxis and anticoagulation after emergency or elective microsurgery. To determine this, the femoral arteries and veins of 16 Sprague-Dawley rats were isolated, sectioned and repaired with microsurgical technique. The animals were then killed at one day intervals from the first to the 16th postoperative day. Femoral veins and arteries were harvested, sectioned and prepared for scanning electron microscopy. The results show that endothelialization of the repair line is begun by day 3 and completed by day 7 in the veins and arteries. Endothelialization of the intraluminal protruding sutures takes nine days in the veins while it is only starting at day 15 in the arteries. If this model can be extended to the human clinical situation, antiplatelet prophylaxis or anticoagulation should be administered for at least seven days. Further study is required to evaluate the thrombogenic potential of intraluminal protruding sutures.
Management of the recurrent sternal wound infection
Authors: Hallock Geoffrey G
Published: February 2017

After adequate sternal debridement or resection for the treatment of a sternal wound infection, muscle flap obliteration of the resulting void has become an accepted standard. Unfortunately, recurrence is not an inconsequential risk as evidenced in six (20.7%) of our patients over the last 10 years. Two of these patients required a second muscle flap transfer before obtaining a healed wound. Since the available regional options for appropriate vascularized flaps is limited, especially with the increased frequency in use of the internal mammary artery for coronary artery bypass grafting, great care must be observed in the selection process not just for closure of the initial wound, but in anticipation of untoward sequela. A schema prioritizing alternatives has been established, so as to maximize the benefit of our workhorse flaps, the pectoralis major or rectus abdominis muscles.
Total thigh flaps as a salvage procedure in paraplegics with massive ulcers
Authors: Fraulin Frankie Og , Lobay Gary W , Moysa Gerald L
Published: February 2017

A small percentage of spinal cord injured (SCI) patients with frequent recurrent pressure sores will eventually develop massive ulcers of the buttocks that are no longer amenable to local tissue coverage. The amputation of one leg and the creation of a total thigh musculocutaneous flap (TTF) may then be appropriate. The purpose of this paper is to evaluate the indications for and the efficacy of this procedure in nine SCI patients who underwent 10 TTF between February 1989 and November 1994. These patients had numerous previous hospitalizations (mean 12.1 admissions) and operations (mean 13.1 operations) for pressure sores. Past psychiatric evaluation found seven of eight males to have a similar history of social, financial and behavioral problems. The typical presentation was a septic, malnourished patient with massive ulceration of his buttocks. Only after wound and patient stabilization was the TTF chosen as a salvage procedure. The operation was long and associated with excessive blood loss. The most common complications were wound dehiscence or partial necrosis (five of 10), sepsis (five of 10), hemodynamic instability (five of 10), and chronic drainage (four of 10). The reoperation rate for complications was six of 10 cases. Long term follow-up (mean 3.5 years) on seven of eight surviving patients showed that these patients had resumed independent living but they had all developed new pressure sores as early as three months post TTF. The underlying risk factors for pressure sores had not changed. The total thigh flap operation remains a last resort procedure in a very small percentage of spinal cord injured patients because of its high morbidity, high reoperative rate for complications, and inability to prevent recurrence of pressure sores.
Ultrapulse carbon dioxide laser resurfacing and facial cosmetic surgery
Authors: Apfelberg David B
Published: February 2017

Over 100 patients have been treated with the ultrapulse carbon dioxide laser since July 1994. The high power square wave pulse of 600 watts at less than 1 msec (which is less than the thermal relaxation time of tissue) dissipates heat during vaporization, thus producing a ‘cold beam’ and decreasing thermal injury. Similarly, hemostatic incision may be achieved by the focus beam at short repetition rates allowing incision with simultaneous coagulation of small vessels. Seventy-four patients underwent resurfacing for rhytides and photo aging with excellent cosmetic results and no texture or pigmentary change. Facial cosmetic surgery (facelift/eyelid lift/forehead lift) was accomplished in 41 patients using the laser scalpel. Patient selection, preparation, sequence of the laserbrasion and incisional techniques are summarized.
A method of treatment of multiple unilateral earlobe clefts
Authors: Hallock Geoffrey G
Published: February 2017

Multiple clefts of an earlobe are a unique problem that may well rise in incidence as a consequence of the changing tides of fashion, since currently adornment with multiple pierced earrings in both sexes has become prevalent. Depending on the location and number of clefts, immediate or sequential correction must preserve a maximum of tissue to prevent a diminutive or asymmetrical lobule. Although many alternatives used to repair the more common solitary cleft are quite acceptable, a variation of the ‘tongue and groove’ flap technique predictably recreates an earlobe with the desired normal appearance and contour.
Canadian survey of reduction mammaplasty techniques
Authors: Carr Michele M , Freiberg Arnis
Published: February 2017

Reduction mammaplasty has become an accepted surgical procedure in North American society. The purpose of this study was to determine the method used by Canadian plastic surgeons to perform this procedure. A survey was sent out to all members of the Canadian Society of Plastic Surgeons in the spring 1993 mailing which questioned them on various aspects of their technique. Response rate was 45% and surgeons did on average 4.6 reduction mammaplasties per month which were covered by provincial health insurance in 96% of cases. The most popular method overall was an inferior pedicle technique, used by 65% of surgeons. Most surgeons altered their procedure in special clinical situations such as small or very large reductions, ptotic breasts, tubular breasts, or second procedures.
Cumulative trauma disorders and carpal tunnel syndrome: Sorting out the confusion
Authors: Mahoney James
Published: February 2017

Chronic work injury will be implicated as a cause of upper extremity musculoskeletal disorders in increasing numbers of patients. A wide variety of conditions, some with a specific diagnosis (eg, carpal tunnel syndrome) and a known response to treatment in contrast to more generalized disorders (eg, tendonitis) where the prognosis is uncertain form part of the spectrum. Experience has demonstrated that as the diagnosis becomes less specific, job related and emotional factors can significantly affect the patient's presentation, response to treatment and timing to return to work. Care needs to be exercised in implicating work in the etiology. General terms such as ‘cumulative trauma disorder’ and ‘repetitive strain injury’ need to be avoided.
A decade of TEN: An update on toxic epidermal necrolysis
Authors: Huq N Sam , Sproat Janet
Published: February 2017

A review of the Hamilton experience over a 10-year period, discussing treatment trends, etiology and outcomes is presented.
Scaphoid fractures
Authors: Richards Robert S , Roth James H
Published: February 2017

Scaphoid fractures are the most common carpal bone fractures and present physicians with many problems. The majority of such fractures (90%) will unite if properly treated; however a scaphoid fracture that goes on to nonunion affects a patient's working capacity for a long period of time. This paper reviews the pathophysiology of the injury and outlines the diagnostic and treatment options available.
Blood Loss of Scalpel versus Cutting Cautery in Bilateral Reduction Mammoplasty Procedures
Authors: Hurst Lawrence N , Kaila Sanjeev
Published: February 2017

Cutting electrocautery may be used for the dissection of breast tissue in bilateral reduction mammoplasty procedures without adverse effects on wound healing. It has been suggested that the use of cutting cautery reduces perioperative blood loss; however, very few studies have been performed to verify this assumption. This study compares the blood loss using cutting cautery with scalpel dissection. The study analyzed the preoperative and one-day postoperative hemoglobin levels of 22 randomly chosen patients dissected with scalpel at University Hospital during 1983, and compared these results with results obtained from 39 randomly chosen patients dissected using cutting cautery in 1993. The results show a difference in the mean postoperative result of 5.77 g/L, which is significant at the 95% confidence level with P>0.03 and P<0.04.
Use of Skin Substitutes in Adult Canadian Burn Centres
Authors: Hopper Richard A , Knighton Judy , Fish Joel , Peters Walter
Published: February 2017

Seventeen Canadian adult burn centres were surveyed to determine the pattern of use, cost and availability of nine skin substitutes. An equal number of centres in the United States with comparable bed capacities were approached for comparison. Eighty-eight per cent of the Canadian centres and 76% of the United States centres responded to the questionnaire. Human cadaver skin, pig skin and Biobrane were used by approximately twice as many United States centres as Canadian centres. Cultured epidermal autografts (CEAs) were used by 20% of the Canadian centres and 15% of the American centres. Opsite, Tegaderm and Duoderm were used widely in both countries. Alloderm was used only in the United States, and amnion was not used in either country. The most common use of each substitute varied among centres, however, the pattern of use was comparable between the two countries, with the exception that Biobrane was not used in Canada to cover donor site wounds. In the United States, 60% of cadaver skin and all CEAs were purchased from private companies, whereas use of these two relatively expensive skin substitutes in Canada was restricted to centres with access to hospital-affiliated skin banks or laboratories. With the dependence of Canadian centres on noncommercial sources of biological skin replacements, research development in established skin banks should be encouraged, and regional discrepancies regarding access to these facilities addressed.
Ulnar Artery Free Flap and the Need for Concern in Its Use: Anatomical Studies and Clinical Experience
Authors: Rebot MTM , Stranc MF , Abdulrauf BM
Published: February 2017

The ulnar artery free flap is one of the choices available when selecting potential donor flaps from the forearm. This flap is reliable and versatile, but its use can potentially devascularize the forearm segment of the ulnar nerve. Clinical experience with this flap has demonstrated that in two of seven patients ulnar nerve dysfunction occurred in the hand. Anatomical studies may reveal a possible cause for this previously unreported finding.
Transblepharoplasty Brow Lift
Authors: Aiache Adrien E
Published: February 2017

The new concepts of endoscopy have taught plastic surgeons to rely on the frontalisgalea-occipitalis unit for brow elevation through inferior release of the frontalis attachment. After proper elevation of the complex through scalp incisions, the technique consists of re-entering the periosteum from below and releasing it from the orbital rim, thus allowing frontalis muscle retractiontotake place without being hindered by the tissue's attachment to the periosteum. Elevation is assured by sutures, screws or skin plication.
Foucher's Antegrade Intramedullary Fixation of Fractures of the Fifth Metacarpal
Authors: Safadi Sm , Al-Qattan Mm
Published: February 2017

Experience with six consecutive patients who were treated with antegrade intramedullary K wire fixation for fifth metacarpal fractures is presented. Differences between the original Foucher's technique and other modified techniques are discussed. Modified Fouch-er's technique is simple and has a low complication rate. However, secondary wire removal (elective or otherwise) should be discussed with all patients preoperatively.
Professional Liability of Plastic Surgeons in Canada
Authors: Callaghan W Bryan
Published: February 2017

The medicolegal experience of Canadian plastic surgeons from 1980 to 1995 was reviewed. During the most recent six years (1990 to 1995) 331 legal actions were closed, and these files were analyzed by the Education Department at the Canadian Medical Protective Association. Lawsuits arose most frequently from breast surgery (26%); facial surgery (21%) and hand surgery (19%) also contributed to lawsuits. Outcomes revealed that cases were often dismissed (64%)or won if they advanced to trial (9%); however, 23% required settlement on behalf of the defendant surgeon, while 4%were lost at trial. The largest damages awarded were in cases arising from hand surgery. The high cost of defending plastic surgeons is a reflection of frequency rather than severity of cases giving rise to legal actions.
How to Centre the Umbilicus Following Rectus Abdominous Myocutaneous Flap Transfers
Authors: Drever J Michael , Habiballah J
Published: February 2017

JM Drever, J Habiballah. How to centre the umbilicus following rectus abdominous myocutaneous flap transfers. Can J Plast Surg 1998;6(1):37-40.

Rectus abdominous myocutaneous and transverse rectus abdominous myocutaneous (TRAM) flaps are increasingly used for breast reconstruction. The navel tends to deviate to one side, mostly in unilateral pedicle cases, when pulled by the muscle closure side. These sequela can be avoided by amputating the umbilicus and reconstructing a new one with a ‘U′-shaped flap or by dragging navels that have a long stalk to the midline. To avoid scar contracture, a ‘V′-shaped flap is inset into the umbilicus.
Misdiagnosis of Breast Implant Rupture with Mammography
Authors: Van Brenk Bert , Mahoney James L
Published: February 2017

B Van Brenk, JL Mahoney. Misdiagnosis of breast implant rupture with mammography. Can J Plast Surg 1998;6(1):17-18.

Diagnosis of intracapsular ruptures of silicone breast implants with mammography can be difficult. A case is presented where mammography was used to diagnose an implant rupture with both a false positive and false negative result in the same patient. The mammographic features of breast implant ruptures are discussed.
Open Carpal Tunnel Release: Comparison of a Long Versus Short Incision
Authors: Kruger Vicki L , Rebot Morris TM
Published: February 2017

VL Kruger, MTM Rebot. Open carpal tunnel release: Comparison of a long versus short incision. Can J Plast Surg 1998;6(2):89-92.

A total of 225 adults with carpal tunnel release of 313 wrists were studied to compare the outcome of a long (at least 3.5 cm) with that of a short (2.0 cm or less) incision technique. The two groups were compared for postoperative complaints, length of time until full function was regained, rate of referral to rehabilitation and the effect of Workers’ Compensation status. The surgical technique and rehabilitation protocol are described. The number and severity of postoperative complaints were significantly reduced in the short incision group. In the non-Workers’ Compensation group, 96% of short incision patients resumed full function within 28 days. This finding compares favourably with published results for endoscopic release, and is superior to results obtained with the long incision. Workers’ Compensation patients required longer to recuperate, with 78% regaining full function within 28 days. of those with Workers’ Compensation, 47% of the long incision group and 27% of the short incision group required out-patient therapy. for the non-Workers’ Compensation group, this percentage decreased to 21% of those with the long incision and 3% with the short incision. A history of vocational or avocational repetitive motion patterns was the most common indicator for therapy and accounted for 67% of rehabilitation referrals.
Dermatofibrosarcoma Protuberans: A Review
Authors: Davison Patrick J , Rowlands Carolyn G , Cartotto Robert C
Published: February 2017

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumour of the dermis. Diagnosis may be very difficult from both a clinical and histopathological standpoint. DFSP has a peak incidence in patients between age 10 and 50 years old, occurs with relatively equal frequency in males and females and has a predilection to occur on the trunk or proximal limbs. The tumour has a very low metastatic potential but can be very locally aggressive, requiring wide surgical resection. The possible variants of DFSP may obscure diagnosis especially in the case of fibrohistiocytic lesions such as dermatofibroma, fibromatosis and malignant fibrous histiocytoma. Immunohistological testing, while not completely specific, shows promise in improving diagnostic accuracy. Wide local excision continues to be the mainstay of treatment, although Mohs’ micrographic surgery may ultimately provide superior cure rates.
Simultaneous Breast Reconstruction with Transverse Rectus Abdominal Myocutaneous (Tram) Flaps
Authors: Sidorov Sv , Vardosanidze Kv , Shevchenko Sp
Published: February 2017

Breast reconstruction with transverse rectus abdominal myocutaneous (TRAM) flaps on pedicles was performed simultaneously with radical mastectomy in 73 patients with breast cancer. In the case of the tumour exceeding the breast borders, or edemo-infiltrative form of cancer, radical mastectomy was accomplished, and the wound defect on the chest wall was closed without technical difficulties, while simultaneously solving the aesthetic part of the operation. Complications were noted in 13 patients (17.8%), and with revision, complications were eliminated without impairing cosmetic effect. Recurrence of the breast cancer was noted in 9.6% of patients, which is explained by the presence of hidden separate metastases not located during the preoperational period or operation. An individual approach in solving the task of simultaneous breast reconstruction with radical mastectomy is necessary in each patient.
Evaluation of a Comprehensive Nondominant Hand Skills Training Program
Authors: Mitchell-Krever Ellen , Lacroix J Michael
Published: February 2017

E Mitchell-Krever, JM Lacroix. Evaluation of a comprehensive nondominant hand skills training program. Can J Plast Surg 1998;6(4):191-195.

A program to teach hand skills with the nondominant hand to patients with significant injuries to the dominant hand was evaluated. Fifty-three patients participated. Highly significant effects of training were observed with respect to all dependent skills variables. Age and sex were noncontributory, with all ages and both sexes exhibiting significant improvements with training. Questionnaire data indicated a high degree of satisfaction with the program, and that the training led to a high rate of vocational success. Surgeons may consider hand skills training programs for their patients with significant dominant hand limitations
Application of the Island Pedicle Latissimus Dorsi Flap for Soft Tissue Coverage of the Elbow
Authors: Harvey Edward J , Aponte Reynaldo , Levin L Scott
Published: February 2017

Soft tissue coverage of large defects at the level of the elbow is a difficult undertaking. Superficial neurovascular elements and a thin subcutaneous covering of the osseous structures do not allow a great variety of coverage options. A systematic reconstruction scheme for tissue defects in the upper extremity, as there is for defects in the lower extremity, does not exist. Coverage of the elbow has traditionally been accomplished with local transpositional flaps or free tissue transfer. At the elbow, local flaps are more likely to be involved in the original disease process. Long operative procedures and dependence on local blood supply, difficulties inherent in free tissue transfer, can be avoided with the use of the pedicled latissimus dorsi flap. This easily tailored flap allows the coverage of large defects at the elbow level. A case series of six patients and a description of the operative technique used for a pedicled island flap of the latissimus dorsi are reported.
Facelifts and Browlifts: Amelioration of Scars
Authors: Camirand André , Doucet Jocelyne
Published: February 2017

In facial rejuvenation, the hairline must be advanced mostly in the frontal and temporal area. The resultant abundance of hair gives an illusion of youth. A method of incision to produce excellent hairline scars is described. Elimination of tension and proper bevelling of the incision facilitate hair growth through and anterior to the scars and make them inconspicuous.
Ulnar Artery Entrapment of the Median Nerve
Authors: Robertson G Andrew , Neumeister Michael W
Published: February 2017

Entrapment of the median nerve is a common focal neuropathy. Many etiological factors have been implicated in this neural compression including inflammation, synovial hypertrophy, ligamentous or fascial bands, tumours, aberrant muscles, trauma, endocrinopathies and vascular lesions. Marked elongation and torsion of the peripheral arteries is an extremely rare cause of this focal neuropathy. A unique case of median nerve entrapment by the ulnar artery in the distal forearm is presented.
A Dislocated Pisiform: Case Report
Authors: Campbell Earl Ad , Magi Enzio
Published: February 2017

Dislocation of the pisiform bone is rare. The present paper describes the 12th reported case of an isolated dislocated pisiform bone and a successful treatment result from closed reduction and splinting.
The Visor Flap: Preservation of Length in Finger Amputations
Authors: Neumeister Michael W , Robertson G Andrew
Published: February 2017

Finger amputations at various levels are common injuries. A wide variety of surgical procedures have been described to obtain closure of open finger wounds. Preservation of length, sensate padding and innocuous scars are among the important goals of finger amputation coverage to maintain adequate function of the injured hand. A new technique in closure of the transverse finger amputation is reported. The visor flap is a bipedicled dorsal flap that takes advantage of the dorsal branches of the volar digital neurovascular bundles to achieve the goals of closure for finger amputations.
Vascularized Fibular Epiphyseal Transplantation for Limb Salvage Following Bone Tumour Excision
Authors: Becker Lisa M , Zuker Ronald M
Published: February 2017

Vascularized fibular transplantation has found wide application for long bone reconstruction in both congenital and acquired defects. However, in children the growth of these transplants is limited and requires the epiphysis if it is to be substantial. Also, the reconstruction of a joint is best achieved with autologus hyaline cartilage. Vascularized fibular epiphyseal transplantation, thus, may play a role in limb salvage procedures in children to both preserve joint function and facilitate long bone growth. The present paper discusses the history of vascularized epiphyseal transplantation both in the laboratory and clinical realm. In discussing its advantages and associated problems, special emphasis is directed at the vascular factors, the endocrine environment, the innervation, mechanical stressors, the recipient site and the donor site. Two case examples are presented to demonstrate the technique, the results and the long term outcome.
Blind Reduction of Mallet Finger Injuries
Authors: Bell Michael Sg , Jarvis James G
Published: February 2017

The present paper outlines a new, superior splinting technique that the authors have used over the past two years in approximately 30 cases of conservative treatment of mallet finger injuries. Its comfort has been uniformly accepted, and no complications with its use have been observed. The high rate of patient compliance is due to the minimal bulk of splint and its comfortable fit, which allows for less restricted finger movement. This splint is readily fabricated, and is an inexpensive and superior alternative to currently available manufactured devices.
Malignant Melanomas Treated By Plastic Surgeons in Hamilton, Ontario: A Retrospective Study of 80 Patients with Clinical and Histological Correlation
Authors: Salama Samih , Cherian Thomas , Levine Mitchell
Published: February 2017

The present retrospective study was designed to analyze the clinical and survival data of 80 patients diagnosed between 1969 and 1987 with confirmed invasive malignant melanoma in Hamilton, Ontario and surrounding region. The age of peak incidence was 31 to 40 years of age for men and 51 to 60 years of age for women. The most frequent type of melanoma was superficial spreading. The most frequent sites were the upper back, ankle and leg. The six-year survival rate for all the patients was 63%. Patients below 50 years of age had a significantly better survival rate than patients above 50 years of age. Survival appears to be inversely proportional to tumour thickness. The findings in this study are similar to those of previous studies regarding clinical features and prognosis. Patient age, and tumour histology and thickness remain important prognostic factors in determining survival for invasive malignant melanoma.
Syphilis Screening
Authors: Goza Mitchell , Kulwicki Ben , Akers Julie M. , Klepser Michael E.
Published: February 2017

Objective: To provide a review on the use, percent positive agreement (PPA), percent negative agreement (PNA), and utilization of Syphilis Health Check for syphilis screening in community pharmacies (in coordination with public health departments) in an effort to increase overall syphilis screening in high-risk populations. Data Sources: PubMed was searched for the following keywords: syphilis, sexually transmitted diseases, diagnosis, public health, point-of-care tests. The search included all dates up to December 2016. Study Selection: Data from studies including the use of the Syphilis Health Check Rapid Immunochromatographic Test were included. Data Synthesis: There are many existing tests to aid in the diagnosis of syphilis. The Syphilis Health Check was compared with these assays using PPA and PNA, where it demonstrated a high level of accuracy in the detection of syphilis antibodies. Conclusion: The Syphilis Health Check Rapid Immunochromatographic Test is a Clinical Laboratory Improvement Amendments–waived assay that has been shown to be easy to use and produces results in minutes. As one of the most accessible health care providers, pharmacists have an opportunity to join the fight against syphilis, and in collaboration with public health departments, screen a vast number of high-risk patients and deliver follow-up care as needed.
Dietary intake is associated with respiratory health outcomes and DNA methylation in children with asthma
Authors: Montrose L. , Ward T. J. , Semmens E. O. , Cho Y. H. , Brown B. , Noonan C. W.
Published: February 2017

Background

Asthma is an increasingly common chronic disease among children, and data point toward a complex mechanism involving genetic, environmental and epigenetic factors. Epigenetic modifications such as DNA hypo- or hyper-methylation have been shown to occur in response to environmental exposures including dietary nutrients.

Methods

Within the context of the asthma randomized trial of indoor wood smoke (ARTIS) study, we investigated relationships between diet, asthma health measures, and DNA methylation. Asthma health measures included a quality of life instrument, diurnal peak flow variability (dPFV) and forced expiratory volume in the first second (FEV1). Dietary intake was assessed with a food frequency questionnaire. Methylation levels of LINE-1 repetitive element and two promoter CpG sites for interferon gamma (IFNγ, -186 and -54) from buccal cell DNA were measured using pyrosequencing assays.

Results

Data were collected on 32 children with asthma living in western Montana who were recruited to the ARTIS study. Selenium and several methyl donor dietary nutrients were positively associated with the asthma quality of life measure. Intake of methyl donating nutrients including folate was positively associated LINE-1 methylation and negatively associated with IFNγ CpG-186. Higher levels of LINE-1 methylation were associated with greater dPFV.

Conclusion

We identified several nutrients that were associated with improved quality of life measures among children with asthma. The IFNγ promoter CpG site -186 but not -54 was associated with the intake of selected dietary nutrients. However, in this small population of children with asthma, the IFNγ promoter CpG sites were not associated with respiratory health measures so it remains unclear through which epigenetic mechanism these nutrients are impacting the quality of life measure. These findings add to the evidence that dietary nutrients, particularly foods containing methyl donors, may be important for epigenetic regulation as it pertains to the control of asthma.

Trial registrationClincialTrials.gov NCT00807183. Registered 10 December 2008
Adjuvant CMF in breast cancer: comparative 5-year results of 12 versus 6 cycles.
Authors: Tancini G , Bonadonna G , Valagussa P , Marchini S , Veronesi U
Published: February 2017

We report the 5-yr results of a prospective randomized study comparing 12 versus 6 cycles of CMF (cyclophosphamide, methotrexate, fluorouracil) with the aim to evaluate the possibility of reducing the duration of adjuvant treatment without compromising the therapeutic effect of the multimodal approach. At 5-yr from mastectomy, both relapse-free survival (CMF 12: 59%; CMF 6: 65.6%) and total survival (CMF 12: 72.7%; CMF 6: 76.9%) were not significantly different in the two treatment groups. Within the two series, no difference was detected between pre- and postmenopausal patients (CMF 12: 59.3% versus 57.6%; CMF 6: 66.5% versus 63.1%), while findings were inversely related to the number of involved axillary nodes. The analysis of relapse-free survival confirmed that in both menopausal groups, relapse-free survival was not significantly affected by estrogen receptor status. Acute toxic manifestations were moderate and reversible. In particular, no drug-induced leukemia nor increased incidence of solid tumors other than breast cancer were documented in this series. Present results after 12 CMF cycles are almost identical to those of our first CMF adjuvant study. Current findings are sufficiently mature to indicate that the maximum tumor cytoreduction with CMF occurs within a relatively short period of time. To improve the results achieved with a single multidrug regimen, more intensive forms of treatment, i.e., utilizing non-cross-resistant combinations, warrant careful evaluation.
Scalp hypothermia: a comparison of ice packs and the Kold Kap in the prevention of doxorubicin-induced alopecia.
Authors: Dean J C , Griffith K S , Cetas T C , Mackel C L , Jones S E , Salmon S E
Published: February 2017

Two methods of scalp hypothermia were compared in preventing alopecia, a side effect of doxorubicin chemotherapy that has a significant psychologic impact on the patient. Thirty-three patients received scalp ice packs consisting of crushed ice in plastic bags. Twenty-nine patients received Kold Kap, a device that produces chilling via an endothermic reaction. Scalp hypothermia was applied for 5-10 min before the doxorubicin bolus and left in place for 30-40 min afterward. The percent of hair loss was rated at each visit and photographs were used to further quantitate any hair loss. Sixty-three percent of Kold Kap and 56% of ice pack patients had good or better protection and did not require wigs. Excellent protection (less than 25% loss) was provided for 51% of Kold Kap and 33% of ice pack patients. Similar protection was provided to Kold Kap patients regardless of dose, while ice pack patients received significantly better protection if their doxorubicin doses were less than 50 mg. Scalp hypothermia is an effective method of preventing doxorubicin-induced alopecia.
Adrenocorticotropic hormone in the prevention of cisplatin-induced nausea and vomiting.
Authors: Colbert N , Izrael V , Lotz J P , Stoppa-Lyonnet D , Vannetzel J M , Pene F , Schlienger M , Laugier A
Published: February 2017

A double-blind trial to evaluate the antiemetic effects of adrenocorticotropic hormone (ACTH) in patients treated with cisplatin was performed. Thirty-seven adults with advanced cancer who were treated with cisplatin were randomly assigned to receive either synthetic long-acting ACTH (1 mg IM given 24 hours, 12 hours, and immediately preceding the administration of cisplatin) or a placebo given under the same conditions. All of the patients received chlorpromazine (50 mg IM) 30 minutes before cisplatin infusion. Patients receiving ACTH and chlorpromazine had significantly fewer episodes of vomiting (p less than 0.01) and shorter periods of nausea (p less than 0.02) than patients receiving placebo and chlorpromazine. Patients receiving ACTH and chlorpromazine were significantly more comfortable than patients receiving placebo and chlorpromazine. No important side effects were observed. ACTH may be an effective agent in preventing nausea and vomiting induced by cisplatin.
Combination cisplatin, vinblastine, and bleomycin chemotherapy (PVB) for malignant germ-cell tumors of the ovary.
Authors: Carlson R W , Sikic B I , Turbow M M , Ballon S C
Published: February 2017

Nine women with germ-cell tumors of the ovary (three endodermal sinus tumors, four immature teratomas, and two mixed germ-cell tumors) were treated with cisplatin, vinblastine, and bleomycin (PVB) chemotherapy after cytoreductive operations. Five patients were stage I, three were stage III, and one patient had recurrent disease. All nine women are alive and without evidence of disease with a median follow-up of 31 months from diagnosis and 27 months since completion of PVB. Treatment toxicity although occasionally severe was rapidly reversible.
Central nervous system involvement in American Burkitt's lymphoma.
Authors: Sariban E , Edwards B , Janus C , Magrath I
Published: February 2017

Sixty-four patients with American Burkitt's lymphoma (AMBL) treated at the National Cancer Institute were reviewed to determine the frequency and characteristics of central nervous system (CNS) involvement. Patients with minimal or completely resected tumor never had CNS disease. Of the 45 patients with more extensive disease, 15 had CNS disease: nine presented with CNS disease, six of whom subsequently had recurrent CNS disease, and six developed CNS disease only at relapse. There was a significant association between CNS and bone-marrow disease at presentation. Therapy of CNS disease consisted of short courses of intrathecal chemotherapy with cytosine arabinoside and methotrexate. Cranial irradiation was given only to patients with CNS relapse. There are six long-term survivors (LTS) who have been disease free for four to six years post chemotherapy. Of these six LTS, three presented with CNS disease, two experienced isolated CNS relapse, and one had CNS disease both at presentation and at relapse. Three of the six LTS never received cranial irradiation. It is concluded that CNS involvement in AMBL can be effectively treated, and that long-term remission, which is probably cure, can be achieved.
Malignant mesothelioma following radiation exposure.
Authors: Antman K H , Corson J M , Li F P , Greenberger J , Sytkowski A , Henson D E , Weinstein L
Published: February 2017

Mesothelioma developed in proximity to the field of therapeutic radiation administered 10-31 years previously in four patients. In three, mesothelioma arose within the site of prior therapeutic radiation for another cancer. Mesothelioma in the fourth patient developed adjacent to the site of cosmetic radiation to a thyroidectomy scar. None of these four patients recalled an asbestos exposure or had evidence of asbestosis on chest roentgenogram. Lung tissue in one patient was negative for ferruginous bodies, a finding considered to indicate no significant asbestos exposure. Five other patients with radiation-associated mesothelioma have been reported previously, suggesting that radiation is an uncommon cause of human mesothelioma. Problems in the diagnosis of radiation-associated mesotheliomas are considered.
Multivariate analysis of prognostic factors in metastatic breast cancer.
Authors: Hortobagyi G N , Smith T L , Legha S S , Swenerton K D , Gehan E A , Yap H Y , Buzdar A U , Blumenschein G R
Published: February 2017

Univariate and multivariate analyses were conducted on data collected from the records of 619 patients with metastatic breast cancer in whom an Adriamycin-containing chemotherapeutic regimen was used. Using a forward, stepwise logistic regression procedure, several models or equations in which a small number of pretreatment factors were incorporated were generated and the probability of response to therapy was accurately predicted. The predictive ability of these models was tested retrospectively in 546 of the 619 patients from whom the data were derived and prospectively in a new population of 200 patients with metastatic breast cancer also treated with a therapeutically equivalent Adriamycin combination. Using similar univariate techniques, pretreatment factors were correlated with the length of survival after therapy. The proportional hazard model of Cox was used to develop a regression model relating survival to pretreatment characteristics in much the same manner as that of the response model. The total population of the initial group of patients was divided according to four levels of hazard ratio, and survival distributions were compared. This model also was tested progressively and its predictive capability was confirmed. The prediction of individual outcome is a valuable capability in the comparison of clinical trials and the continuing evaluation of biologic changes in patients with metastatic carcinoma; such a method is described in this paper.
A randomized trial of five and three drug chemotherapy and chemoimmunotherapy in women with operable node positive breast cancer.
Authors: Tormey D C , Weinberg V E , Holland J F , Weiss R B , Glidewell O J , Perloff M , Falkson G , Falkson H C , Henry P H , Leone L A
Published: February 2017

Women with breast carcinoma and four or more involved ipsilateral axillary lymph nodes were randomly assigned to receive an induction course and 2 yr of maintenance chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil (CMF, 150 patients), CMF plus vincristine and prednisone (CMFVP, 166 patients), or chemoimmunotherapy with CMF plus the methanol extraction residue of BCG (CMF-MER, 85 patients). After 5 yr of accrual and a median follow-up of 34 mo, CMFVP is superior to CMF (p less than 0.01) with disease-free survival estimates at 4 yr of 60% for CMFVP compared to 45% for CMF. The disease-free survival advantage of CMFVP over CMF was greater in postmenopausal (p = 0.02) than in premenopausal patients (p = 0.09). CMF-MER was similar to CMF alone. CMF related side effects were similar in each regimen (see text), except for a greater incidence of leukopenia during induction with CMF than with CMFVP (p less than 0.01).
Guidelines for publishing papers on cancer clinical trials: responsibilities of editors and authors.
Authors: Zelen M
Published: February 2017

Guidelines are proposed for the reporting of clinical trials. These are meant to be used for both authors and journal editors. Specific proposals are made for: reporting the population under study, actual therapy used, describing the study design, accounting of patients, follow-up statistics, and describing the quality control of the data. Nonrandomized studies require special discussion. Such studies potentially have substantial biases which can lead to incorrect conclusions. Six areas of biases arising in nonrandomized studies are pointed out which should require a discussion in an acceptable published paper. The presentation of statistical results and the reporting of early studies present unusually difficult problems. Guidelines are presented for statistical analyses which, although simple to implement in practice, are not generally used. A proposal is made for the publication of early results of a study which require that the authors agree to follow and periodically report on their trial to the journal editor. If the early conclusions change with additional follow-up, the editor should notify its readers. The adoption of these guidelines can be an important force in raising the scientific level of the reporting of clinical trials.
Effects of cloned human leukocyte interferons in the human tumor stem cell assay.
Authors: Salmon S E , Durie B G , Young L , Liu R M , Trown P W , Stebbing N
Published: February 2017

Clonogenic tumor cells from fresh biopsies of human cancers were cultivated in vitro and tested for sensitivity by continuous exposure to pharmacologically achievable concentrations of either of two highly purified human leukocyte interferon subtypes (IFN-alpha A and IFN-alpha D) prepared by recombinant DNA methods. The interferons were compared on a weight basis at concentrations of 0.4 and 4.0 ng/ml (equivalent to 80 and 800 units of interferon activity for IFN-alpha A and 2.0 and 20 units for IFN-alpha D). Inhibition of tumor colony-forming units (50% of control or less) was observed in 38.1% of the 273 tumors tested against IFN-alpha A, and in 16% of the 71 tumors tested against IFN-alpha D. Of the tumor types with at least ten samples tested against IFN-alpha A, the percentage of cases exhibiting inhibition was as follows: melanoma (51.7%), lung cancer (50%), myeloma (33.4%), ovarian cancer (33.9%), sarcoma (33.3%), adenocarcinoma of unknown primary (30.4%), breast cancer (28%), acute leukemia (30.8%), and renal cancer (23%). More marked inhibition (30% of control or less) was observed in 18.7% of all tumors tested against IFN-alpha A. Of 60 melanomas tested, 18 (30%) exhibited marked in vitro inhibition of growth with IFN-alpha A. Although a smaller number of tumors (71) were tested against IFN-alpha D on a weight basis, it appeared, in general, to be slightly less active than IFN-alpha A (p less than 0.01), and only 8% of tumors tested exhibited marked inhibition over the same dosage range of interferon. Comparison of the dose-response curves for the 68 tumors tested simultaneously against both interferons did not reveal marked interpatient differences in the inhibition curves, although IFN-alpha D was slightly less active overall. Tumors exhibiting at least 50% inhibition of tumor colony formation also proved to be sensitive to a significantly larger number of cytotoxic drugs (tested simultaneously) than the tumors not inhibited with interferon (p less than 0.0001 for IFN-alpha A). We conclude that the in vitro clonogenic assay may aid in targeting tumor types most likely to exhibit interferon sensitivity and assist in case selection for entry into clinical trials with cloned interferons.