Differences in dermatology training abroad: A comparative analysis of dermatology training in the United States and in India.

Dermatology residency training is not standardized internationally, and each country dictates how training is conducted within its own borders. This article highlights the types of variability in training that can occur from country to country by comparing dermatology residency training programs in the United States and India. This article specifically analyzes the differences that pertain to application and selection, residency program structure, and post-residency opportunities.

Multiple apocrine hidrocystomas successfully treated with botulinum toxin A.

Apocrine hidrocystomas, while rare, present predominantly as solitary papules occurring in the periocular region of the face. Various treatment modalities for these lesions exist depending on their size and location, but the management of multiple hidrocystomas can be more challenging. Recent reports illustrate that multiple eccrine hidrocystomas have been successfully treated with botulinum toxin A. Herein we describe the effective use of botulinum toxin A in a 29-year-old man with multiple facial apocrine hidrocystomas, which, to our knowledge, has not yet been reported in the English-language literature.

An in vitro mechanical comparison of tibial plateau levelling osteotomy plates.

An in vitro mechanical study was performed to compare the fatigue properties and the loads to failure of four plate designs that are used to stabilise the tibial plateau levelling osteotomy (TPLO). Seventy-two gapped osteotomy models were created using 3.5 mm versions of the following plates: a standard TPLO plate, a low profile TPLO plate, a locking TPLO plate (LocP), and a broad locking TPLO plate (bLocP). The 18 constructs for each plate design were sub-divided into three identical groups of six. Six constructs were mounted in a materials testing device and subjected to cyclic compressive loading until failure was observed or one-million cycles were achieved. Additionally, six constructs of each plate design were tested in compressive axial loading and six others in four-point bending in a load-to-failure manner. To provide residual strength comparisons, the six constructs undergoing cyclic fatigue compression testing were also tested in axial compressive loading. There were not any significant differences in stiffness between plates tested in axial compressive loading. However, mean loads at failure were higher for the LocP and bLocP constructs. The bLocP had a significantly higher mean stiffness and mean load at failure compared to the other constructs tested in four-point bending.

Reversing click polarity may uncover auditory neuropathy in infants.

OBJECTIVE: To identify patients with primary auditory neuropathies whose cochlear potentials to a 100 microsec click persist after click cessation and simulate synchronous auditory brain stem responses (ABRs) at high intensities. DESIGN: ABRs to condensation and rarefaction clicks, as well as Maximum Length Sequence ABRs and one transtympanic electrocochleogram (ECochG), were collected from five infants with absent middle ear muscle reflexes and normal or near normal otoacoustic emissions. These infants failed ALGO screens, which used alternating polarity clicks, and/or failed full ABRs done elsewhere with alternating polarity clicks. RESULTS: When ABRs were collected in response to a single polarity pulse, they revealed robust and reproducible wave forms over 4 to 6 msec that initially were mistaken for a normal ABR by the referring agents. However, when condensation and rarefaction click data are compared, the waveforms change polarity when the stimulus is inverted. Furthermore, the waveforms fail to shift in latency as the intensity of the stimulation is reduced. Transtympanic ECochG on one of the children revealed the same polarity reversal and fixed latency functions, confirming that they were cochlear rather than neural responses. CONCLUSIONS: Comparing responses with positive versus negative polarity clicks may help separate ABRs from cochlear potentials and alert clinicians to the possibility of an auditory neuropathy. Therefore, absent or abnormal ABRs in the presence of normal otoacoustic emissions need not always implicate a purely "central disorder," but might be consistent with dysfunction between outer hair cells and primary afferent fibers.

Clinical experience with ciprofloxacin: analysis of a multicenter study.

In a multicenter study of 90 patients treated with ciprofloxacin (mean daily dosage, 936 mg per day; mean duration of treatment, 9.7 days) for a variety of infections, 42 were microbiologically proven. For one case the outcome of therapy was unknown. Of the 41 reported outcomes bacteriologic cure resulted in 92.7%, improvement in 7.3% of cases. Clinical cure equaled 88.4%, while improvement was 9.3%. Failure was reported in 2.3% of cases. A total of 14 infections were classified as chronic. Overall, there were 9/90 (10%) adverse reactions. Six were classified as definitely related to therapy. Therapy with ciprofloxacin was discontinued in four (4.4%) patients because of adverse effects.

In vitro adsorption of sodium pentobarbital by SuperChar, USP and Darco G-60 activated charcoals.

This study was designed to examine the in vitro adsorption of sodium pentobarbital by three activated charcoals. Solutions of sodium pentobarbital (20 mM) were prepared in distilled water and in 70% sorbitol (w/v). Radiolabeled (14C) sodium pentobarbital was added to each solution to serve as a concentration marker. Two ml of each drug solution was added to test tubes containing 40 mg of either Darco G-60, USP, or SuperChar activated charcoal. The drug-charcoal mixtures were incubated at 37 degrees C for O, 2.5, 5, 7.5 or 10 min. Equilibrium, indicated by a constant percentage of drug bound for two consecutive time periods, was established immediately for the aqueous mixtures and for Darco G-60 in sorbitol. The time to equilibrium was prolonged for USP (2.5 min) and SuperChar (5 min) in the presence of sorbitol. In the second series of experiments, solutions of sodium pentobarbital (1.25 to 160 mM) were prepared in either distilled water or sorbitol. Amount of drug bound by 10 to 320 mg of activated charcoal within a 10 min incubation period was determined. Scatchard analysis determined maximum binding capacity (Bmax) and dissociation constants (Kd) for each activated charcoal. In water, Bmax (mumoles/gm) was greatest for SuperChar (1141), followed by USP (580) and Darco G-60 (381), while the Kd's did not differ. Sorbitol did not change the Bmax or Kd of USP or Darco G-60, but the additive significantly decreased the Bmax (717) and increased the Kd for SuperChar (3.3 to 10.1 mM). The results suggest that relative binding capacity of activated charcoal is directly proportional to surface area, and that sorbitol significantly reduces sodium pentobarbital binding to SuperChar.

Effects of activated charcoal and sorbitol on sodium pentobarbital absorption in the rat.

Three activated charcoals were tested for their ability to reduce the oral absorption of sodium pentobarbital (SP) in rats. Fasted adult, male rats were given 40 mg/kg of C-14 labelled SP by gavage (2 ml). Five minutes after drug administration, the animals were given 40 mg of either Darco (G-60), United States Pharmacopeia (USP) or SuperChar (SC) activated charcoals. The charcoals were administered as a slurry in either 1 ml of water, or 1 ml of 70 percent (w/v) sorbitol solution. Water (control) and sorbitol given alone were tested separately. Various pharmacokinetic parameters were calculated from the plasma concentration of SP determined at various time intervals after drug administration. When given in water, only SC significantly (p less than .01) reduced the peak plasma concentration and oral bioavailability of SP. Sorbitol given alone produced diarrhea but did not affect drug absorption. However, sorbitol selectively enhanced the effectiveness of G-60 and USP charcoals and, as a result, all charcoals significantly reduced SP absorption when given along with the cathartic. The results suggest that when given in water, charcoal antidotal effectiveness is proportional to absorptive surface area, and that sorbitol may enhance the antidotal effectiveness of some charcoals but not others.

The telescoping plugged catheter in suspected anaerobic infections. A controlled series.

The results of bacterial cultures from transtracheal aspiration and from aspirations obtained by a new telescoping plugged catheter were compared in specimens taken from 13 patients with suspected anaerobic infections of the lower respiratory tract. When all bacterial isolates (potential aerobic pathogens, aerobic nonpathogens, and anaerobes) were counted with transtracheal aspiration as the standard method for comparison, cultures of material obtained by the telescoping plugged catheter technique yielded 22 false negatives and 14 false positives. The results of the 2 methods were in complete agreement in only 3 paired specimens cultured aerobically and in only 6 paired specimens cultured anaerobically. When only potential aerobic pathogens and anaerobes were considered with transtracheal aspiration as the standard method for comparison, cultures of material obtained by the telescoping plugged catheter technique yielded 11 false negatives and 7 false positives, and the results of the 2 methods were in complete agreement in 9 paired specimens cultured aerobically and 6 paired specimens cultured anaerobically. Our results suggest that fiberoptic bronchoscopy using the telescoping plugged catheter technique may be an acceptable method for collecting specimens from the lower respiratory tract, but further studies comparing this method with transtracheal aspiration are needed.

Correction of sickle cell gnathopathy by total maxillary osteotomy.

Medical advances in the care of individuals with sickle cell disease have progressed to the level where elective surgical procedures can be performed. Successful management of these individuals requires understanding of the pathophysiology of the disease in conjunction with specific anaesthetic and surgical considerations. The clinical relevance of these factors are discussed as they relate to haematological, anaesthetic, and surgical management of a young black male who underwent a modified LeFort I osteotomy with segmentalization and genioplasty to correct a severe dentofacial deformity secondary to sickle cell gnathopathy.

Probable myeloblastic leukemoid reaction with disseminated sarcoidosis.

A 55-year-old woman had progressive weakness, weight loss, night sweats, fever, right-sided facial weakness, and hepatomegaly. Reticulonodular infiltrates were seen on chest x-ray film and a central filling defect was noted on liver scan. Study of the peripheral blood was noted on liver scan. Study of the peripheral blood revealed pancytopenia and myeloblasts. The bone marrow was not markedly hypercellular but contained noncaseating granulomas and myeloblasts. The patient's condition deteriorated and she died on the 22nd hospital day. Autopsy disclosed disseminated sarcoidosis but no evidence of leukemic infiltrates. Although concomitant "smoldering" acute leukemia cannot be ruled out, the findings in this patient can be best explained on the basis of a myeloblastic leukemoid reaction accompanying sarcoidosis.