bluuebunny/crossref_metadata_2025_split huggingface dataset:
Achilles Tendon Rupture in Women
Authors: Vosseller J. Turner , Ellis Scott J. , Levine David S. , Kennedy John G. , Elliott Andrew J. , Deland Jonathan T. , Roberts Matthew M. , O’Malley Martin J. 
Published: January 2017

Background: The incidence of Achilles rupture appears to be less in women, although this notion has not been specifically investigated in the literature. Methods: The medical records of 7 foot-and-ankle orthopaedic surgeons at 1 institution were reviewed by Current Procedural Terminology (code 27650) and International Classification of Diseases–9 (code 727.67) to establish all Achilles tendon ruptures seen and/or treated by these surgeons. Sex, age, side, and mechanism of injury were recorded. Whether the patient had an acute Achilles tendon rupture or nonacute Achilles pathology was also noted. Results: A total of 468 patients were identified, of whom 358 had acute ruptures: 302 male and 56 female (5.39:1). Patients with acute ruptures were significantly younger than those with nonacute pathology (43.8 vs 55.1, P < .001). For acute ruptures, the mean age was not significantly different between men and women (43.9 vs 43.2; P = .780). Athletic activity was causative in 243 of 302 men (80.5%) and in 40 of 56 women (71.4%). This difference was not statistically significant ( P = .130). Six men (2.0%) and 6 women (10.7%) had comorbidities that were thought to increase their risk of rupture ( P = .005). Conclusion: Achilles tendon rupture is more common in men than women. Previous studies using the aforementioned codes to identify patients without chart review may have overestimated the number of women with acute Achilles tendon rupture. Level of Evidence: Level III, retrospective comparative series.
Effect of Various Hallux Valgus Reconstruction on Sesamoid Location
Authors: Huang Eddie H. , Charlton Timothy P. , Ajayi Samuel , Thordarson David B. 
Published: January 2017

Background: The correction of sesamoid subluxation is an important component of hallux valgus reconstruction with some surgeons feeling that the sesamoids can be pulled back under the first metatarsal head when imbricating the medial capsule during surgery. The purpose of this study was to radiographically assess the effect of an osteotomy on sesamoid location relative to the second metatarsal. Methods: This is a retrospective radiographic study review of 165 patients with hallux valgus treated with reconstructive osteotomies. Patients were included if they underwent a scarf or basilar osteotomy for hallux valgus but were excluded if they had inflammatory arthropathy or lesser metatarsal osteotomy. A modified McBride soft tissue procedure was performed in conjunction with the basilar and scarf osteotomies. Each patient’s preoperative and postoperative radiographs were evaluated for hallux valgus angle, intermetatarsal 1-2 angle, tibial sesamoid classification, and lateral sesamoid location relative to the second metatarsal. Result: The greatest correction of both hallux valgus and intermetatrsal 1-2 angle was achieved in basilar osteotomies (20.6 degrees and 9.7 degrees, respectively), then scarf osteotomies (14.4 degrees and 8.7 degrees, respectively). Basilar and scarf osteotomies both corrected medial sesamoid subluxation relative to the first metatarsal head an average of 2-3 classification stages. All osteotomies had minimal lateral sesamoid location change relative to the second metatarsal. Conclusion: The majority of sesamoid correction correlated with the intermetatarsal 1-2 correction. The concept that medial capsular plication pulls the sesamoids beneath the first metatarsal (ie, changes the location of the sesamoids relative to the second metatarsal) was not supported by our results. Level of Evidence: Level III, retrospective case series.
The Sense of Relationship in Women Who Have Encountered Abuse
Authors: Farrell Marian L. 
Published: January 2017

BACKGROUND. This study was built on previous work (Farrell, 1992) that explored the sense of healing in women who encountered abuse. Relationship, one of the main themes of the study, was defined as the integration of all aspects of the self and a sense of connectedness between self and others. A sense of relationship was a central aspect in the healing of women who participated in the study. The relational model used as part of the conceptual framework for the study describes bow a woman's sense of self develops because of the relationships that occur within her life. OBJECTIVES: The purpose of the study was to explore the sense of relationship in women who encountered abuse. STUDY DESIGN: A phenomenologic approach was used. This method involves description, reduction, essences, and intentionality. Seventeen women who responded to notices in local newspapers agreed to complete the study. The data collection methods used in the study included in-depth interviewsfield notes, and demographic data sheets. RESULTS: The results of the study provided an understanding of the relational sense of self in women who encounter abuse. Four major themes evolvedfrom the study: lack of relational authenticity. immobility, emptiness, and disconnection. CONCLUSIONS: As a result of the study, more appropriate interventions directed to ward relational development can be actualized for women who encounter abuse.
Impact of the Number of Dermatologists on Dermatology Biomedical Research: A Canadian Study
Authors: Lanzini Rosilene Canzi , Fallen Robyn S. , Wismer Judy , Lima Hermenio C. 
Published: January 2017

Background: Fewer dermatologists than other clinical specialists are entering and being retained as physicians in the Canadian medical workforce. Studies suggest that dermatologist numbers may influence skin disease outcomes. No study has questioned whether the number of clinical dermatologists can influence academic productivity. Objective: To quantify the correlation of the number of dermatologists with biomedical scientific production in this field from 1996 to 2008 in Canada. Methods: Canadian dermatology biomedical scientific production from SCImago Journal & Country Rank (SJR) were merged with Canadian Medical Association (CMA) dermatologist demographic data. Linear regression analyses were used to model the relationships. Results: The low growth of dermatologist numbers by 8.16% in Canada from 1996 to 2008 correlates with a small increase in articles by 7.59% published in this subject area during this period. This has reduced the scientific importance of Canadian dermatology in the world. Conclusion: The number of dermatologists was a significant predictor of biomedical research production in the field of dermatology. This suggests that specialist availability may be one factor influencing dermatology research and publications.
Granuloma Pyogenicum as a Complication of Decorative Nose Piercing: Report of Eight Cases from Eastern India
Authors: Ghosh Sudip Kumar , Bandyopadhyay Debabrata 
Published: January 2017

Background: Body piercing has become a common fashion trend globally, irrespective of social classes and age groups. Almost no external organ in the human body has escaped piercing. Nose piercing is a fairly common practice all over the world. A number of local and systemic complications (both infectious and noninfectious) may follow nose piercing. Piercing by nonprofessional or unskilled persons, use of nonsterile piercing instruments, and poor standards of hygiene in the care of the puncture site are the most important factors accountable for such complications. Objective and Conclusion: We report here a case series of eight patients who presented with nasal granuloma pyogenicum following decorative nasal piercing to highlight a relatively rare but potentially serious complication of the procedure. The role of adopting appropriate sterile techniques for preventing such complication is emphasized.
Sister Mary Joseph's Nodule
Authors: Davar Sandra , Hanna Dominique 
Published: January 2017

Background: Sister Mary Joseph's nodule (SMJN) represents an unusual clinical feature of metastatic deposit at the umbilicus originating from an intra-abdominal malignancy. Objective: To outline the paucity of such a condition, review the associated pathologies, and demonstrate the importance of clinical and histopathologic correlation. Methods: Case report of a 75-year-old man with vesical and prostatic cancers treated 2 years prior to presenting with an umbilical lesion. Histopathologic and radiologic examinations were performed to confirm the clinical diagnosis. Results: Histopathology of the umbilical biopsy revealed a carcinoma of urothelial origin, but immunohistochemistry suggested a squamous cell carcinoma. Clinically, the lesion did not support a diagnosis of primary squamous cell carcinoma; in addition, the positron emission tomographic scan revealed a captation at the ureterovesical junction that was compatible with vesical cancer relapse. Conclusion: SMJN is a rare but typical cutaneous metastasis of internal malignancy, and its recognition is of great importance because it may be the first presenting sign in a patient with an unknown malignant disease.
Gastric Leiomyoma and Hyperplastic Polyposis Coli in a Patient with Multiple Cutaneous and Uterine Leiomyomatosis
Authors: Serra David , Amaro Pedro , Gonçalo Margarida , Silva Mário , Ferrando Barbara , Pasini Barbara , Figueiredo Américo 
Published: January 2017

Background: Cutaneous leiomyomatosis has been associated with multiple uterine myomas and, more recently, with germline heterozygous mutations of the FH gene and certain types of renal cancer. Despite the growing amount of knowledge concerning this genodermatosis, its clinical spectrum remains incompletely characterized. Objective: We report the observation of a patient with multiple cutaneous and uterine leiomyomatosis (MCUL) with unusual gastrointestinal manifestations. Methods and Results: A gastric leiomyoma was diagnosed on a 38-year-old female MCUL patient on endoscopy performed because of mild dyspepsia. Furthermore, routine colonoscopy disclosed hyperplastic polyposis. Genetic testing revealed a previously not reported mutation of the FH gene. Conclusion: Gastrointestinal lesions such as the present ones are frequently asymptomatic and probably underdiagnosed. As the phenotypical spectrum associated with mutations of the FH gene keeps expanding, clinicians should keep in mind that, besides renal cancer, other unexpected tumors could also arise in this setting.
Intralesional Methotrexate Treatment for Keratoacanthoma Tumors: A Retrospective Case Series
Authors: Aubut Nicolas , Alain Jimmy , Claveau Joël 
Published: January 2017

Background: Intralesional methotrexate (IL-MTX) is an effective treatment for keratoacanthoma. Objective: We sought to determine the response rates and adverse events in KA treated with intralesional methotrexate. Methods: All cases of KA treated with intralesional methotrexate at our institutions from 2001 to 2009 were systematically reviewed. Results: Forty-six cases of KA treated with IL-MTX were identified. A complete resolution was achieved in 74% of patients, requiring an average of 1.8 injection sessions, for a mean total dose of 10 mg. Adverse events did not occur. Limitations: The follow-up period was short, and there was no histologic confirmation of the initial diagnosis. Conclusion: IL-MTX is an effective and well-tolerated alternative to surgery for the treatment of KA.
Potential Role of Neurogenic Inflammatory Factors in the Pathogenesis of Vitiligo
Authors: Yu Richard , Huang Yuanshen , Zhang Xuejun , Zhou Youwen 
Published: January 2017

Background: Vitiligo is a highly complex multifactorial condition of the skin that has an unclear mechanism of pathogenesis. Objective: This review summarizes the role of various neurogenic inflammatory factors significantly upregulated in vitiligo. Methods: A literature review was conducted of all pertinent data regarding neuropeptides that are altered in vitiligo and their possible role in the destruction of melanocytes. Results: The close associations between the skin, immune system, and nervous system, along with specific changes demonstrated in vitiligo patients, support a pathogenic mechanism of vitiligo that involves neuroimmunologic factors, the release of which can be governed by mental stress. Conclusion: Neuropeptides and nerve growth factors are critical regulators of emotional response and may precipitate the onset and development of vitiligo in certain predisposed individuals. More studies are required to investigate whether a direct link exists between genetics, mental stress, and neurogenic factors in vitiligo.
Necrobiosis Lipoidica Diabeticorum in a Tattoo Site
Authors: Babin-Muise Dominique , Miller Robert , Murray Scott , Walsh Noreen 
Published: January 2017

Background: Trauma is an immediate triggering factor in the development of necrobiosis lipoidica diabeticorum (NLD). NLD has previously never been documented in a tattoo site. Objective and Conclusion: Here we report an otherwise healthy 35-year-old woman with an area of NLD located in a tattoo site. Initial injection with intralesional triamcinalone acetonide showed no benefit. Subsequent application of betamethasone valerate cream did not lead to improvement of the lesion.
Botanicals With Dermatologic Properties Derived From First Nations Healing: Part 2—Plants and Algae
Authors: Colantonio Sophia , Rivers Jason K. 
Published: January 2017

Introduction: Plants and algae have played a central role in the treatment of skin conditions in both traditional First Nations healing and in modern dermatology. The objective of this study was to examine the evidence supporting the dermatological use of seaweed, witch hazel, bearberry, and mayapple. Methods: Four plants and algae used in traditional First Nations treatments of skin disease were selected based on expert recommendations. Several databases were searched to identify relevant citations without language restrictions. Results: Seaweed has potential clinical use in the treatment of acne and wrinkles and may be incorporated into biofunctional textiles. Witch hazel is an effective and well-tolerated treatment of inflammation and diaper dermatitis. Bearberry leaves contain arbutin, a skin-lightening agent that is an alternative for the treatment of hyperpigmentation. Mayapple contains podophyllotoxin, a treatment for condyloma accuminata, molluscum contagiosum, and recalcitrant palmoplantar warts. Discussion: Common plants and algae are replete with bioactive agents that may have beneficial effects on the skin. Further research will open the door to new and innovative products in the future. Limitations of this study include that the scope of our study is limited to 4 plants and algae, a small sample of the breadth of plants used by First Nations for dermatological treatments.
A Rare Case of Oestrogen Dermatitis
Authors: Bourgeault Emilie , Bujold Janie , Doucet Marie-Eve 
Published: January 2017

Background: Oestrogen dermatitis is a rare disorder characterised by cyclical eruptions in association with a woman’s menstrual cycle. Methods: A 43-year-old woman with an 8-year history of cyclical inguinal dermatitis, with a negative patch test, was tested with intradermal progesterone and oestrogen. Results: Intradermal testing was positive for oestrogen only. Conclusion: In a female patient with cyclical dermatitis, it is important to consider oestrogen or progesterone dermatitis in the differential diagnosis.
Evaluation of the Efficacy of Cryosurgery in Patients With Sebaceous Hyperplasia of the Face
Authors: Ataş Hatice , Gönül Müzeyyen 
Published: January 2017

Background: Cryosurgery is an effective treatment for sebaceous hyperplasia, but there have been few clinical studies. Objectives: The aim of this study was to evaluate the efficacy and safety of cryosurgery in the treatment of sebaceous hyperplasia. Methods: Cryosurgery was performed 6 times, at 2-week intervals, with liquid nitrogen, and evaluated in 40 patients with 517 lesions ranging from 2 to 9 mm over the forehead, cheeks, and chin. All of the lesions were measured before and after the treatment. Results: The mean age of the participants was 54.7 ± 8.9 years, and the male/female ratio was 21/19 (1.1). The mean time of the disease duration was 4.2 ± 3.0 years. After 6 cooling cycles, an excellent response (76%-100%) was seen in 341 patients (65.9%), a very good response (51%-75%) was seen in 102 (19.7%), a good response (26%-50%) was seen in 57 (11.1%), a poor response (1%-25%) was seen in 15 (2.9%), and no response (0%) was seen in 2 (0.4%). Age ( P = .004) and sex ( P < .0001) were independent predictors of an excellent response. The excellent response rates were 71.4% for males, 61.8% for females, 70.4% for ages older than 55 years, and 61.8% for ages younger than 55 years. Temporary hyperpigmentation was found in 5 lesions (0.96%), and recurrence was not seen at the 4-month follow-up. Conclusions: The well-aimed and controlled used of cryosurgery is an effective method for treating significant cosmetic disfigurement in patients with sebaceous hyperplasia. It is a low-cost therapy without scarring, hypopigmentation, or recurrence.
Does General Practitioner Gatekeeping Curb Health Care Expenditure?
Authors: Delnoij Diana , Van Merode Godefridus , Paulus Aggie , Groenewegen Peter 
Published: January 2017

Objectives: It is generally assumed that health care systems in which specialist and hospital care is only accessible after referral by a general practitioner (GP) have lower total health care costs. In this study, the following questions were addressed: do health care systems with GPs acting as gatekeepers to specialized care have lower health care expenditure than those with directly accessible specialist care? Does health care expenditure increase more rapidly in countries without a referral system than in those with the GP acting as a gatekeeper? Methods: Multiple regression analyses on total and ambulatory health care expenditure in 18 OECD countries. Results: Analyses showed only one statistically significant effect ( P< 0.05) in countries with gatekeeping GPs: ambulatory care expenditure has increased more slowly than in non-gatekeeping systems. No significant effects of gatekeeping were found on the level of ambulatory care costs, or on the level or growth of total health care expenditure. As in earlier studies, the most important factor influencing aggregate health care costs and their growth is gross national product (GNP), followed by the share of public funding. Relationships that exist at a micro level (such as lower costs with a gatekeeping primary care doctor) did not show up in aggregate data at a macro level. Conclusions: Gatekeeping systems appear to be better able to contain ambulatory care expenditure. More research is necessary to understand micro level mechanisms and to distinguish the effects of gatekeeping from other structural aspects of health care systems.
Principal—Agent Relationships in General Practice: The First Wave of English Personal Medical Services Pilot Contracts
Authors: Sheaff Rod , Lloyd-Kendall Andrew 
Published: January 2017

Objectives: To investigate how far English National Health Service (NHS) Personal Medical Services (PMS) contracts embody a principal—agent relationship between health authorities (HAs) and primary health care providers, especially, but not exclusively, general practices involved in the first wave (1998) of PMS pilot projects; and to consider the implications for relational and classical theories of contract. Methods: Content analysis of 71 first-wave PMS contracts. Results: Most PMS contracts reflect current English NHS policy priorities, but few institute mechanisms to ensure that providers realise these objectives. Although PMS contracts have some classical characteristics, relational characteristics are more evident. Some characteristics match neither the classical nor the relational model. Conclusions: First-wave PMS contracts do not appear to embody a strong principal—agent relationship between HAs and primary health care providers. This finding offers little support for the relevance of classical theories of contract, but also implies that relational theories of contract need to be revised for quasi-market settings. Future PMS contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs. PMS contracts will also need to be longer-term contracts in order to promote the ‘institutional embedding’ of independent general practice in the wider management systems of the NHS.
Clinicians' Attitudes to Recruitment to Randomised Trials in Cancer Care: A Qualitative Study
Authors: Langley Carole , Gray Selena , Selley Sara , Bowie Cameron , Price Chris 
Published: January 2017

Objectives: To explore attitudes to and problems experienced with recruitment into randomised trials in cancer care. Methods: In-depth semi-structured interviews with a purposive sample of 20 hospital clinicians in the South West of England identified from 192 participants in a larger postal survey. Interviews were recorded on audiotape and fully transcribed. Data were analysed by comparing transcripts and describing emergent themes. Results: Clinicians do not always find it easy to identify key randomised trials in their area of interest. Even when they identify those trials in which they would like to participate, they are not always able to recruit patients. Although recruitment can be hindered by the time and administration involved and the resources needed, the attitudes of clinicians to research in general, the design of randomised trials, clinicians' concerns regarding individual patients and patients' preferences for different treatments also present major barriers. Other factors of concern include the imposition of strict eligibility criteria and the expense and complexity of monitoring and follow-up. Conclusion: Barriers to recruitment depend on the clinicians' individual situations and on a complex combination of factors. Action is needed to promote awareness of randomised trials under way, to ensure that trials address issues of importance, are acceptable to patients and clinicians, and that practical support is provided for participating centres.
Who are the High Hospital Users? A Canadian Case Study
Authors: Roos Noralou , Burchill Charles , Carriere Keumhee 
Published: January 2017

Objectives: Researchers have taken two different approaches to understanding high use of hospital services, one focusing on the large proportion of services used by a small minority and a second focusing on the poor health status and high hospital use of the poor. This work attempts to bridge these two widely researched approaches to understanding health care use. Methods: Administrative data from Winnipeg, Manitoba covering all hospitalizations in 1995 were combined with public use Census measures of socio-economic status (neighbourhood household income). High users were defined as the 1% of the population who spent the most days in hospital in 1995 ( n = 6487 hospital users out of population of 648 715 including non-users). Results: One per cent of the Winnipeg population consumed 69% of the hospital days in 1995. Thirty-one per cent of the highest users were among the 20% of residents of neighbourhoods with the lowest household incomes, and 10% of the highest users were among the 20% from neighbourhoods with the highest household incomes. However, on most other dimensions, including gender, age, average days in hospital, average admissions, percentage who died in hospital and diagnostic reasons for being hospitalized, the similarities between high users, regardless of their socio-economic group, were striking. Conclusions: The lower the socio-economic status, the more likely an individual is to make high demands on hospitals. However, patterns of use as well as the diseases and accidents that produce high use among residents of low income neighbourhoods are not much different from those that produce high use among residents of high income neighbourhoods.