A 39-year-old housewife sustained inadvertent trauma to the right index finger about 6 years ago, whilst stitching clothes. A couple of weeks later, the site of trauma became hard and gritty. Ever since, it has progre...A 39-year-old housewife sustained inadvertent trauma to the right index finger about 6 years ago, whilst stitching clothes. A couple of weeks later, the site of trauma became hard and gritty. Ever since, it has progressed slowly, without any appreciable outward sign. It was not associated with any discomfort/pain. Consequent on an opinion from a surgeon, it was decided to operate on the right index finger. During the operation, under local anesthesia, a hard and gritty material was removed. The material was subjected to histopathologic study. Several stitches were applied to the wound. It failed to respond to antimicrobial therapy over a 4- week period, prompting the patient to seek another opinion. Examination of the skin surface revealed a plaque with an irregular configuration on and around the distal interphalangeal joint of the right index finger. It was erythematous and pigmented. The top of the plaque was irregular and had alternating elevations and depressions (Fig. 1). Diascopy was negative for apple jelly nodule. A bacillus Calmette- Gué rin (BCG) vaccination scar was identified on the left deltoid. There was no regional lymphadenopathy or systemic abnormality. Mantoux test with intradermal injection of 0.1 mL SPAN’ s tuberculin (purified protein derivative/5 tuberculin units/0.1 mL) (Span Diagnostic Ltd., Murat, India) was negative after 72 h. Investigations, including total and differential leukocyte count, erythrocyte sedimentation rate, serum biochemistry, and renal and liver function tests, were within the normal range, as was a chest X- ray. Hematoxylin and eosin- stained sections prepared from the biopsy taken from the lesion revealed noteworthy changes in the epidermis and the dermis. The former was marked by the presence of hyperkeratosis, acanthosis, and papillomatosis, whilst the latter contained tubercle granulomas. Each of the granulomas was well formed and consisted of large numbers of lymphocytes, histiocytes, and foreign body (Langerhans’ ) giant cells (Fig. 2). Caseation necrosis and acid- fast bacilli could not be demonstrated. The preceding revelations were fairly conducive to the diagnosis. Accordingly, antitubercular therapy (ATT), comprising 450 mg of rifampicin, 300 mg of isonicotinic acid hydrazide, and 800 mg of ethambutol, was recommended for oral administration each day for 60 days. The outcome of the treatment was satisfactory, resulting in perceptible regression of the skin lesion (Fig. 1b). The patient was advised to continue the treatment for another 30 days, after which 450 mg of rifampicin and 300 mg of isonicotinic acid hydrazide were to be continued for another 6 months.展开更多
Background:Generalists within the UK have for many years been performing mino r surgical procedures. Little has been published concerning this activity. Objec tives:To determine the management of skin malignancy in a ...Background:Generalists within the UK have for many years been performing mino r surgical procedures. Little has been published concerning this activity. Objec tives:To determine the management of skin malignancy in a UK general practice i n order to allow comparison of activity with other practices and disciplines and to identify areas for research. Methods:Retrospective cohort study in an urban 4-partner general practice of 10,000 patients. Total ascertainment of all diag nosed skin malignancies over 10 years achieved by undertaking computerised searc hes. Results:136 skin malignancies were identified in 101 patients. The recurre nce rates for basal cell carcinomas managed in primary care were comparable to r ates published for secondary care. A quarter of patients developed a metachronou s skin malignancy or a recurrence. Conclusion:Almost half of all skin malignanc ies were wholly managed within primary care. There appeared to be no consistent pattern of management. There is a need for research and consensus on optimal car e.展开更多
意识障碍(disorders of consciousness,DOC)由急性昏迷发展而来,通常在两周内完成进展,期间是以完全缺乏觉醒和觉知为特征的一种短暂状态。随着神经危重症护理的进步,越来越多的严重脑损伤患者存活下来,DOC患者的数量也在不断增加[1]。...意识障碍(disorders of consciousness,DOC)由急性昏迷发展而来,通常在两周内完成进展,期间是以完全缺乏觉醒和觉知为特征的一种短暂状态。随着神经危重症护理的进步,越来越多的严重脑损伤患者存活下来,DOC患者的数量也在不断增加[1]。在其治疗上有着较为多样化的方式,其中经颅直流电刺激(transcranial direct current stimulation,tDCS)作为一种无创性脑刺激(non-invasive brain stimulation,NIBS)技术,具有安全、价格低廉,操作相对简单且易于与其他治疗方法相结合等优势,近年来兴起并发展迅速[2]。本文就tDCS在意识障碍治疗领域的一些主要应用进行综述。展开更多
文摘A 39-year-old housewife sustained inadvertent trauma to the right index finger about 6 years ago, whilst stitching clothes. A couple of weeks later, the site of trauma became hard and gritty. Ever since, it has progressed slowly, without any appreciable outward sign. It was not associated with any discomfort/pain. Consequent on an opinion from a surgeon, it was decided to operate on the right index finger. During the operation, under local anesthesia, a hard and gritty material was removed. The material was subjected to histopathologic study. Several stitches were applied to the wound. It failed to respond to antimicrobial therapy over a 4- week period, prompting the patient to seek another opinion. Examination of the skin surface revealed a plaque with an irregular configuration on and around the distal interphalangeal joint of the right index finger. It was erythematous and pigmented. The top of the plaque was irregular and had alternating elevations and depressions (Fig. 1). Diascopy was negative for apple jelly nodule. A bacillus Calmette- Gué rin (BCG) vaccination scar was identified on the left deltoid. There was no regional lymphadenopathy or systemic abnormality. Mantoux test with intradermal injection of 0.1 mL SPAN’ s tuberculin (purified protein derivative/5 tuberculin units/0.1 mL) (Span Diagnostic Ltd., Murat, India) was negative after 72 h. Investigations, including total and differential leukocyte count, erythrocyte sedimentation rate, serum biochemistry, and renal and liver function tests, were within the normal range, as was a chest X- ray. Hematoxylin and eosin- stained sections prepared from the biopsy taken from the lesion revealed noteworthy changes in the epidermis and the dermis. The former was marked by the presence of hyperkeratosis, acanthosis, and papillomatosis, whilst the latter contained tubercle granulomas. Each of the granulomas was well formed and consisted of large numbers of lymphocytes, histiocytes, and foreign body (Langerhans’ ) giant cells (Fig. 2). Caseation necrosis and acid- fast bacilli could not be demonstrated. The preceding revelations were fairly conducive to the diagnosis. Accordingly, antitubercular therapy (ATT), comprising 450 mg of rifampicin, 300 mg of isonicotinic acid hydrazide, and 800 mg of ethambutol, was recommended for oral administration each day for 60 days. The outcome of the treatment was satisfactory, resulting in perceptible regression of the skin lesion (Fig. 1b). The patient was advised to continue the treatment for another 30 days, after which 450 mg of rifampicin and 300 mg of isonicotinic acid hydrazide were to be continued for another 6 months.
文摘Background:Generalists within the UK have for many years been performing mino r surgical procedures. Little has been published concerning this activity. Objec tives:To determine the management of skin malignancy in a UK general practice i n order to allow comparison of activity with other practices and disciplines and to identify areas for research. Methods:Retrospective cohort study in an urban 4-partner general practice of 10,000 patients. Total ascertainment of all diag nosed skin malignancies over 10 years achieved by undertaking computerised searc hes. Results:136 skin malignancies were identified in 101 patients. The recurre nce rates for basal cell carcinomas managed in primary care were comparable to r ates published for secondary care. A quarter of patients developed a metachronou s skin malignancy or a recurrence. Conclusion:Almost half of all skin malignanc ies were wholly managed within primary care. There appeared to be no consistent pattern of management. There is a need for research and consensus on optimal car e.
文摘意识障碍(disorders of consciousness,DOC)由急性昏迷发展而来,通常在两周内完成进展,期间是以完全缺乏觉醒和觉知为特征的一种短暂状态。随着神经危重症护理的进步,越来越多的严重脑损伤患者存活下来,DOC患者的数量也在不断增加[1]。在其治疗上有着较为多样化的方式,其中经颅直流电刺激(transcranial direct current stimulation,tDCS)作为一种无创性脑刺激(non-invasive brain stimulation,NIBS)技术,具有安全、价格低廉,操作相对简单且易于与其他治疗方法相结合等优势,近年来兴起并发展迅速[2]。本文就tDCS在意识障碍治疗领域的一些主要应用进行综述。
