Development and formative evaluation of a foot self-care program for African Americans with diabetes.

African Americans with diabetes have a higher rate of lower-extremity amputation due to diabetic foot complications than the general public. Education about proper foot care can help prevent serious diabetic foot complications and assist in early detection of problems. The purpose of this project was to develop, formatively evaluate, and pilot test a self-care, take-home program for the prevention of foot problems in African Americans with diabetes. The program included a brief, one-on-one orientation session and a take-home foot self-care packet. Through telephone follow-up subjects reported the following: good to excellent overall rating of the program, favorable reactions to the patient instruction booklet, an overwhelming positive response to the large hand mirror, and a positive effect on their daily foot-care practices. The Afrocentricity of the patient education materials was preferred by younger subjects; older subjects found this approach too restrictive.

Evaluation of the efficacy and toxicity of the cyclosporine A-flucortolone-methotrexate combination in the treatment of sarcoidosis.

Eleven patients with chronic sarcoidosis resistant to high-dose corticosteroids and other immunosuppressive treatments were treated with cyclosporine A at the initial daily dose of 5 mg per kg body weight (ideal weight in the case of overweight subjects) combined with flucortolone and methotrexate. A complete and lasting remission of the disease was obtained in all patients with total disappearance of pulmonary and extrapulmonary manifestations. In addition, the disease activity indexes normalized and remained normal for the rest of the follow-up period (24.82 +/- 8.22 months, range 12-33). No renal or hepatic toxicity was observed in any patient. Two of them presented hypertrichosis and one nausea.

Aspecific bronchial hyperreactivity in pulmonary sarcoidosis.

Aspecific bronchial hyperreactivity (A.B.H.) is a condition found mostly in cases of bronchial asthma, but it may also present in other pathologies affecting the respiratory tract. This study examines 30 patients presenting hilo-pulmonary sarcoidosis, 27 asthmatic patients and 25 healthy subjects as controls. The three groups were sex and age matched. No significant difference in smoking habits between controls and sarcoidosis patients was found. Patients were tested for aspecific bronchial hyperreactivity by administering increasing doses of methacholine. Methacholine inhalation was performed following a dosimetric method. Aspecific bronchial hyperreactivity was found in 6 (20.6%) of sarcoidosis patients with a significant frequency (p < 0.05). No statistically significant difference was found for mean PD20FEV1 values, but the difference between asthma and sarcoidosis patients was highly significant (p = 0.003). No statistically significant difference was found between basal FEV1 means expressed as a percentage of the former in asthmatics and sarcoidosis patients, both responsive and unresponsive. Although it is difficult to draw conclusions from these findings, aspecific bronchial hyperreactivity was seen to increase in subjects with sarcoidosis, and this may explain the not rare association between asthma and sarcoidosis.

[Mycoplasma pneumoniae pneumonia. Can radiologic features suggest the etiologic agent?]. / La polmonite da Mycoplasma pneumoniae. Gli aspetti radiologici possono indirizzare verso l'agente eziologico?

The present study was aimed at evaluating whether Mycoplasma pneumoniae (MP) pneumonia presents with typical X-ray patterns which can help its diagnosis. The chest films of 32 adult patients with serologically proven MP infections were reviewed. Confluent or patchy consolidation was the most common finding (66% of patients), interstitial involvement was much less frequent (19%), and so were "mixed" patterns (15%). Unilateral involvement was common (69%), the lower lobes were frequently involved (52%) and in 78% of cases only one lobe was affected. Pleural fluid (40%) and atelectasis (31%) were commonly seen, while hilar adenopathy was rare (9%). In substantial agreement with previous studies, no distinctive X-ray pattern of MP pneumonia was found and marked differences were seen to exist in its radiographic appearance. Despite these obstacles, some characteristic X-ray findings were suggestive of MP pneumonia: diffuse/localized interstitial involvement appeared to be the most helpful sign, in combination with clinical and epidemiologic data. On the contrary, patchy and acinar consolidations are slightly suggestive of MP etiology.