Nail bed trauma reconstruction and artificial nail replacement - a case report.

Nail bed reconstruction is crucial after fingertip trauma, impacting both function and aesthetics. In this article, the authors describe a case of partial distal phalanx amputation of the index finger with laceration of the nail bed's remaining part. A traumatically elevated skin-fat flap covered the exposed bone on the fingertip, preserving finger length and sensitivity on the radial side. A full-thickness skin graft from the forearm closed a secondary defect on the finger pulp. Nail bed suturing prevented scarring and nail deformity, and a temporary artificial plastic nail replacement maintained the nail bed's shape. Temporary artificial nail replacements protect the regenerating fingertip bed, promote healing, and prevent nail deformities. Proper adaptation of lacerated nail bed edges, supported by either the patient's own nail or a temporary artificial nail, is crucial for optimal fingertip restoration, including proper nail shape.

Transition from intravenous or subcutaneous prostacyclin therapy to inhaled treprostinil in patients with pulmonary arterial hypertension: a retrospective case series.

WHAT IS KNOWN AND OBJECTIVE: Inhaled treprostinil represents an attractive alternative to the other available prostacyclin formulations by obviating the use of continuous infusions and its associated risks. Published evidence describing the process of transition from infusion prostacyclin therapy to inhaled treprostinil is limited. The purpose of this report is to describe an inpatient protocol for transitioning patients with pulmonary arterial hypertension (PAH) from intravenous (IV) or subcutaneous (SQ) prostacyclin therapy to inhaled treprostinil. METHODS: A retrospective case cohort study was performed evaluating medical records of three patients undergoing transition from IV/SQ continuous infusion prostacyclin therapy to inhaled treprostinil. The transition protocol and clinical data were collected prospectively. RESULTS AND DISCUSSION: Haemodynamics, six-min walk distance (6MWD), World Health Organization (WHO) functional class, modified Borg Dyspnea Score and brain natriuretic peptide prior to and after transition remained similar. All patients were receiving concomitant oral PAH medications prior to and after conversion. Adverse effects during the change were mild. No patients discontinued inhaled treprostinil following transition. At long-term follow-up, functional class remained stable at WHO functional class II or better. Patient 1 and Patient 3 demonstrated stable to modest improvement in 6MWD, whereas Patient 2 had a slight decrease in 6MWD. The transition to inhaled treprostinil from IV/SQ infusion prostacyclin therapy appears to be safe in carefully selected patients. WHAT IS NEW AND CONCLUSION: Our report describes a standard method used to transition patients from IV/SQ infusion prostacyclin to inhaled treprostinil.

Right aortic arch detected in fetal life.

OBJECTIVE: To evaluate the prenatal distribution, associated conditions and outcome of the different types of right aortic arch (RAA) detected in fetal life. METHODS: This was a retrospective review of all cases of RAA detected prenatally between 1998 and 2005 in two tertiary referral centers. RESULTS: In the study period 71 cases of RAA were detected; 26 (37%) had RAA with aberrant left subclavian artery, 23 (32%) had RAA with mirror-image branching, 20 (28%) had RAA of unknown type and two (3%) had double aortic arch. While 20/26 cases with RAA and aberrant left subclavian artery were isolated findings, all 23 cases with RAA and mirror-image branching were associated with cardiac defects, namely tetralogy of Fallot (43%) or pulmonary atresia with ventricular septal defect (22%). Of the 20 cases with RAA, 19 of unknown type were associated with heterotaxy syndromes and had additional cardiac malformations and ambiguities of the situs. The two cases with DAA were isolated findings. Seven cases in our series (10%) had a microdeletion 22q11 and these were significantly associated with extracardiac malformations. The outcome in our series depended solely on the associated cardiac and extracardiac malformations, with the exception of one infant with isolated DAA, in whom a surgical correction was warranted. CONCLUSIONS: RAA detected in fetal life is associated frequently with other cardiac/non-cardiac malformations, heterotaxy syndromes and microdeletions 22q11. The associated conditions vary depending on the branching type of the brachiocephalic vessels and the presence of extracardiac malformations.

Hugoniot data of plastic foams obtained from laser-driven shocks.

In this paper we present Hugoniot data for plastic foams obtained with laser-driven shocks. Relative equation-of-state data for foams were obtained using Al as a reference material. The diagnostics consisted in the detection of shock breakout from double layer Al/foam targets. The foams [poly(4-methyl-1-pentene) with density 130 > rho > 60 mg/cm3] were produced at the Institute of Laser Engineering of Osaka University. The experiment was performed using the Prague PALS iodine laser working at 0.44 microm wavelength and irradiances up to a few 10(14) W/cm2. Pressures as high as 3.6 Mbar (previously unreached for such low-density materials) where generated in the foams. Samples with four different values of initial density were used, in order to explore a wider region of the phase diagram. Shock acceleration when the shock crosses the Al/foam interface was also measured.

"Active back school", prophylactic management for low back pain: three-year follow-up of a randomized, controlled trial.

The purpose of the present study was to investigate the long-term effect of the Active Back School programme on minimizing recurrences of episodes of low back pain. Forty-three subjects were randomly allocated to the Active Back School group and 38 to the control group. There were no significant differences between the groups with regard to baseline characteristics. The Active Back School programme comprised 20 lessons each divided into a 20-min theoretical and a 40-min exercise part during a 13-week period. Nine participants (11%) dropped out during the study period. Recurrence of new low back pain episodes was significantly less (p = 0.04), and the time from inclusion to the first new low back pain episode was significantly on the side of the Active Back School group (p < 0.01). The duration of sick leave was found to be significantly shorter (p < 0.01) in the Active Back School group compared to the control group. The Active Back School reduced the recurrence and severity of new low back pain episodes at 36 months' follow-up.

Classification of problems, clinical findings and treatment goals in patients with low back pain using the ICIDH-2 beta-2.

PURPOSE: This study aimed to explore problems, clinical findings and treatment goals presented by patients with low back pain and their physiotherapists, and to which extent this information could be classified according to the ICIDH-2 Beta-2. METHOD: An explorative field trial of 12 physiotherapists and 28 patients with low back pain in outpatient practices. RESULTS: Pain and impairments related to muscles, joints and structures of the lower back, pelvis and hips were most often presented. Functioning related to daily activities and participation in society was often described in the treatment goals, but vaguely formulated. Most of the problems and clinical findings could be classified according to the ICIDH-2 Beta-2. However, several treatment goals could not be classified. CONCLUSIONS: There was a lack of specification in several of the detailed codes of the Body, Function and Structure Dimension, particularly regarding classification of pain and muscle functions. The main limitation concerned the detailed version of the Body Function and Structure Dimension, which provided no additional precision compared with the short version when classifying pain and other impairments. However, the ICIDH-2 offers a tool to enhance the precision of clinical findings and the possibilities for performing a multidimensional evaluation of functioning related to patients with low back pain.

Exercises and education as secondary prevention for recurrent low back pain.

BACKGROUND AND PURPOSE: Exercise and education is a common physiotherapy approach in the prevention of low back pain. A Mensendieck exercise programme consisting of exercises and ergonomical education has, in a previous study, been shown to be effective in preventing recurrent low back pain during one-year follow-up. The purpose of the present study was to evaluate the long-term effect of the Mensendieck exercise programme on people with recurrent episodes of low back pain who, when entering the study, had finished treatment for their last episode of low back pain. METHOD: A randomized controlled clinical trial in which 41 women and 36 men were allocated to either a Mensendieck or control group. The Mensendieck subjects received 20 group sessions of exercises and ergonomical education over 13 weeks. The control subjects were not offered any prophylactic therapy, but were free to receive treatment or exercises. Outcome measures were the number of recurrences of low back pain, sick leave, low back function and general functional status. RESULTS: At three-year follow-up, 11 subjects had been lost to the study. Survival analysis showed a significant reduction (p = 0.02) in subjects experiencing recurrent low back pain in the Mensendieck group compared to the control group. Significant improvements in pain and function scores were reported in both groups. There was no significant difference between the groups in pain, function or sick leave. CONCLUSION: A Mensendieck exercise programme seems efficient in reducing recurrent episodes of low back pain at three-year follow-up, but it did not influence sick leave, pain or function scores.

[Congenital hip dysplasia in Ostfold 1990-96]. / Medfødt hofteleddsdysplasi i østfold 1990-96.

BACKGROUND: The focus in this paper is on the prevalence, risk factors and treatment of developmental dysplasia of the hip (DDH), before and after introduction of sonographic examination in 1993. MATERIAL AND METHODS: 1,469 (8.2%) infants were followed up because of clinical findings or risk factors (542 with X-ray and 927 with sonographic examination). RESULTS: The overall prevalence of DDH was 1.14%; 0.92% in neonates and 0.22% as late DDH. The prevalence of late DDH ranged from 0.07% to 0.52% (p < 0.01) with peaks in spring and autumn. The following changes occurred when sonography was introduced: Newborn DDH decreased from 1.06 to 0.77% (p < 0.05), late DDH decreased from 0.26 to 0.19% (not significant), and treatment duration decreased from 6.2 months (SD 1.4) to 4.2 months (SD 1.3)(p < 0.01). 56 of 198 infants with clinical findings (28%) were confirmed to have sonographic DDH (p < 0.01). Previous risk factors were confirmed. Mothers of infants with late DDH had higher pre-pregnancy weight, 63 kg (SD 11) vs 58.5 kg (SD 7.8), p < 0.02) and lower weight gain in the last trimester, (4.2 kg (SD 2.2) vs 6.6 kg (SD 2.7; p < 0.001), compared to a reference population. INTERPRETATION: Sonography has reduced treatment rate and duration of DDH.

The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up.

STUDY DESIGN: A prospective, randomized, controlled trial with a stratification block design in which a Mensendieck exercise program was compared with the experience of a control group. OBJECTIVE: To evaluate the effect of a Mensendieck program on the incidence of recurrent episodes of low back pain in patients with a history of the condition who currently are working. SUMMARY OF BACKGROUND DATA: One episode of low back pain increases the risk of further episodes of the condition. The Mensendieck approach combines education and exercise. This approach has been used for many years in Scandinavia and the Netherlands. However, the effects on low back pain have not been evaluated previously in a randomized, controlled trial. METHODS: A total of 77 men and women, mean age 39.6 years (range, 21.2-49.8 years), who had finished treatment for a low back pain episode, were stratified according to incidence of low back pain episodes and symptoms of sciatica over the preceding 3 years. The patients were assigned at random to either the Mensendieck program or a control group. The Mensendieck group received 20 group sessions of exercises and ergonomic education in 13 weeks. At 5- and 12-month follow-up examinations, the patients were assessed for recurrence of low back pain, days of sick leave, low back pain, and functional scores. RESULTS: After 12 months, there was a significant reduction in recurrent low back pain episodes in the Mensendieck group compared with the control group (P < 0.05). There was a trend toward fewer days of sick leave because of low back pain in the Mensendieck group, but no significant differences between the groups. There was reduction in pain and improvement in function in both groups, with no significant differences between the groups. CONCLUSIONS: A secondary prophylaxis Mensendieck exercise program of 20 group sessions significantly reduced the incidence of low back pain recurrences in a population with history of the condition. However, there were no differences between the groups with regard to days of sick leave, low back pain, and function.

Active back school: prophylactic management for low back pain. A randomized, controlled, 1-year follow-up study.

STUDY DESIGN: A randomized, controlled, single-center trial with a stratified group design. OBJECTIVE: To investigate the secondary prophylactic effect of the Active Back School program on minimizing recurrences of low back pain episodes. SUMMARY OF BACKGROUND DATA: The results of back school interventions are controversial. Previous work often used short intervention periods and low doses of practical training. However, studies with the highest methodologic scores have shown the best results, especially when conducted in occupational settings and coupled with a comprehensive rehabilitation program. METHODS: By block randomization, 19 men and 24 women were allocated to Active Back School, with 18 men and 20 women as control subjects. The Slumps test and number of low back pain episodes during the previous 36 months were used as stratification factors. There were no significant differences between the groups with regard to demographic factors and initially observed variables. Active Back School consisted of 20 lessons over a 13-week period. Each lesson was divided into a 20-minute theoretical part and a 40-minute exercise part. All participants were examined on enrollment, then 5 and 12 months after initiation of the program. Outcome measures were recurrence of low back pain episodes and number of days of sick leave. RESULTS: The recurrence of new low back pain episodes was significantly lower (P < 0.05) and the time from inclusion to the first new episode significantly longer (P < 0.01) in the Active Back School group than in the control group. In the Active Back School group, seven participants took sick leave because of low back pain episodes during the first 12 months of follow-up compared with 11 among the control subjects. The number of sick leave days was significantly lower (P < 0.05) in the Active Back School group than in the control group. CONCLUSION: Active Back School reduced the recurrence and severity of new low back pain episodes according to results of follow-up examinations performed 5 and 12 months after enrollment.

[A new type of construction of artificial heart valves]. / Nová konstrucia umelých srdcových chlopní.

All mechanical valve prosthesis have a moving part that during systole totally or partially obstructs the opening area of the valve. As the result the flow of blood to the left ventricle or to the aorta is restricted. The authors present mechanical valve proSthesis with central opening during diastole and have its function similar to the human valve.

Organ donation from the family of a totally brain-dead donor: professional responsiveness.

Authoritative literature and clinically relevant data related to organ donation from a TBD family member lend support that organ donation is a multifaceted and challenging opportunity. These sources call forth multi-professional responsiveness in clinical practice, education, research, public policy, and ethics as advances in organ procurement and transplantation intensify. In turn, opportunities are rich for professionals to appreciate and to receive in new ways organ donation as a gift on behalf of society.

[Incidence of antibodies against leptospira in the blood of breeding sows]. / Výskyt protilátek proti leptospirám v krevním séru chovných prasnic.

Within a year, 4438 blood sera of sows coming from 25 farms of the Strakonice district were subjected to serological examination by the reaction of microagglutination lysis (RMAL) with 12 strains of Leptospira. The reaction was positive in 3.22% of all the blood sera. Separate significant titres were demonstrated in the reaction with the Leptospira organisms of four serological groups, including Grippotyphosa, Icterohaemorrhagiae, Hebdomadis and Australis. The reactions with the Leptospira of the Canicola serological group were observed only individually as coagglutination with a simultaneous occurrence of antibodies to Leptospira of the Grippotyphosa serological group. The highest number of reactions 119 (75.8%) was demonstrated in titre 400.