ABSTRACT
We report three cases of interdigital pilonidal sinus including a case of a woman with this condition. Previous reports that surgical excision is curative in all cases are not supported by our experience.
Subject(s)
Barbering , Fingers/surgery , Hair , Occupational Diseases/surgery , Pilonidal Sinus/surgery , Adult , Female , Fingers/pathology , Giant Cells, Foreign-Body/pathology , Hair/pathology , Humans , Male , Middle Aged , Occupational Diseases/etiology , Occupational Diseases/pathology , Pilonidal Sinus/etiology , Pilonidal Sinus/pathology , Risk Factors , Wound Healing/physiologyABSTRACT
OBJECTIVE: To determine if hypocapnia occurs in patients with fear of falling and to explore potential causes of hypocapnia. DESIGN: Observational study in patients who fall with and without fear of falling. SETTING: Rehabilitation wards of an elderly care unit. PATIENTS: Consecutive fallers with (n = 20) and without (n = 10) fear of falling. MAIN OUTCOME MEASURES: End-tidal CO2 (PETCO2) and respiratory rate (RR) responses were measured during sustained isometric muscle contraction (SIMC) (40% of maximum voluntary contraction of quadriceps for 2 min) and during a 5-meter walk. Falls efficacy scale (FES) and Hospital anxiety and depression scale (HAD). RESULTS: Patients with fear of falling had significantly higher FES and HAD scores (p < .01). During SIMC, baseline and nadir PETCO2 levels were significantly lower in patients with a fear of falling (p < .01). During the 5-meter walk, PETCO2 was lower at baseline, at nadir, and at the end of the walk in the fear of falling group than in controls (p < .01). RR was higher at nadir and end of the walk in the fear of falling group than in controls (p < .02). CONCLUSIONS: Hypocapnia may occur in patients with a fear of falling during SIMC and walking. Anxiety seems to be the main cause, but muscle weakness may contribute. Breathing or relaxation techniques and reconditioning may have a role in treating fear of falling in the rehabilitation setting.
Subject(s)
Accidental Falls , Anxiety/complications , Fear/psychology , Hypocapnia/diagnosis , Hypocapnia/etiology , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/psychology , Female , Humans , Hypocapnia/psychology , Isometric Contraction , Male , Pulmonary Gas Exchange , Respiration , WalkingABSTRACT
We report a case of pyoderma gangrenosum affecting both hands simultaneously. Pyoderma gangrenosum affecting the hands is an extremely rare condition which may result in considerable tissue destruction. Management includes immunosuppressant therapy, treatment of associated medical conditions and minimal surgical intervention. Despite a high maintenance dose of corticosteroid and adequate control of coexisting ulcerative colitis and rheumatoid arthritis, tissue destruction in the hands spread rapidly in our patient. The key to the patient's dramatic improvement was the tissue biopsy suggesting pyoderma gangrenosum and the subsequent treatment with the cytotoxic immunosuppressant, azathioprine.
Subject(s)
Hand/surgery , Pyoderma Gangrenosum/surgery , Amputation, Surgical , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Azathioprine/administration & dosage , Biopsy , Colitis, Ulcerative/complications , Colitis, Ulcerative/diagnosis , Debridement , Diagnosis, Differential , Female , Hand/pathology , Humans , Immunosuppressive Agents/administration & dosage , Middle Aged , Pyoderma Gangrenosum/pathology , Skin/pathologyABSTRACT
A comparison was made between high-performance liquid chromatography (HPLC) and gas chromatography-mass spectrometry (GC-MS) as methods for determining bupivacaine in human plasma. Both methods utilized pentycaine as an internal standard, were found to be linear in the range 5-320 ng and had acceptable precision and accuracy. The precision for the HPLC method was better than that for the GC-MS method. The limits of detection of the HPLC and GC-MS methods were ca. 1.0 and 0.1 ng, respectively. Good agreement between the HPLC and GC-MS methods was obtained for the analysis of samples taken from a patient receiving bupivacaine topically. For most purposes the HPLC method would be slightly better. However, for samples containing interfering peaks GC-MS provides a higher degree of resolution from such interferants.
Subject(s)
Anesthetics, Local/blood , Bupivacaine/blood , Administration, Topical , Chromatography, High Pressure Liquid/methods , Gas Chromatography-Mass Spectrometry/methods , HumansSubject(s)
Achievement , Child Rearing , Handwriting , Parents/education , Child, Preschool , Female , Humans , MaleABSTRACT
In a family study in which thirty-four patients with osteochondritis dissecans and eighty-six of their first-degree relatives were examined clinically and radiologically, only one relative was found to have osteochondritis dissecans. No association with other forms of osteochondritis, endocrinological abnormalities or dwarfism was found.
