Trends in the presentation and surgical management of the acute diabetic foot.

Background: This study examines trends in the presentation and surgical management of acute diabetic foot problems in a single institution.

Method: Prospective audit of all diabetic patients who had a primary procedure for critical lower limb ischaemia (CLI) and/or foot sepsis between 1st January 1990 and 31st December 2002. Primary and secondary intervention, mortality and limb salvage rate within 6 weeks of the index procedure were recorded.

Intra-abdominal packing for uncontrollable haemorrhage during ruptured abdominal aortic aneurysm repair.

Objective: Intra-abdominal packing is a valuable adjunct in patients with abdominal trauma and uncontrollable bleeding but few data exist regarding early and late outcome associated with this technique in patients with ruptured abdominal aortic aneurysm (AAA).

Methods: Interrogation of a prospective vascular surgical database identified 23 patients (22 men; median age 69, range 59-82, years) with ruptured AAA who required intra-abdominal packing for control of coagulopathic haemorrhage after insertion of an aortic graft between January 1982 and December 2003. Co-morbidity, operative and outcome data were retrieved.

The validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice.

Background: Despite the increasing sophistication of vascular surgical practice, more than three decades after its introduction to clinical practice, the ankle to brachial pressure index (ABPI) remains the cornerstone of non-invasive assessment of the patient with symptomatic peripheral arterial disease (PAD).

Aim: To summarise what is known about ABPI and critically appraise its validity, reliability, reproducibility and extended utility.

Methods: A MEDLINE (1966-2004) and Cochrane library search for articles relating to measurement of ABPI was undertaken; see text for further details.

Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair.

Objective: Whole body hypoperfusion and lower torso ischaemia-reperfusion contribute to post-operative organ dysfunction in patients undergoing repair of ruptured abdominal aortic aneurysm (AAA). Serum lactate and base deficit are markers of tissue ischaemia and are used to assess the adequacy of resuscitation. This study examines the prognostic value of immediate post-operative levels of serum lactate and base deficit in ruptured AAA.

On the relationship between encapsulated ultrasound contrast agent and pressure.

Noninvasive measurement of pressure within the heart cavities and other internal organs (e.g., kidney, liver) has significant clinical value, but currently is not feasible.

Assessment of smoking status in patients with peripheral arterial disease.

Objective: To assess the utility of a novel rapid urinary cotinine assay to detect and quantify the level of smoking in patients with peripheral arterial disease.

Methods: This was a cross-sectional study in a vascular surgical outpatient department of a large teaching hospital. Participants were 100 consecutive subjects presenting to a hospital outpatient clinic with a diagnosis of intermittent claudication confirmed by a positive Edinburgh claudication questionnaire and an ankle-brachial pressure index of less than 0.

Extracellular ATP induces cytokine expression and apoptosis through P2X7 receptor in murine mast cells.

Extracellular ATP and other nucleotides act through specific cell surface receptors and regulate a wide variety of cellular responses in many cell types and tissues. In this study, we demonstrate that murine mast cells express several P2Y and P2X receptor subtypes including P2X(7), and describe functional responses of these cells to extracellular ATP. Stimulation of bone marrow-derived mast cells (BMMC), as well as MC/9 and P815 mast cell lines with millimolar concentrations of ATP, resulted in Ca(2+) influx across the cellular membrane and cell permeabilization.

Tumor necrosis factor (TNF) interferes with insulin signaling through the p55 TNF receptor death domain.

Tumor necrosis factor (TNF) contributes to insulin resistance by binding to the 55kDa TNF receptor (TNF-R55), resulting in serine phosphorylation of proteins such as insulin receptor (IR) substrate (IRS)-1, followed by reduced tyrosine phosphorylation of IRS-1 through the IR and, thereby, diminished IR signal transduction. Through independent receptor domains, TNF-R55 activates a neutral (N-SMase) and an acid sphingomyelinase (A-SMase), that both generate the sphingolipid ceramide. Multiple candidate kinases have been identified that serine-phosphorylate IRS-1 in response to TNF or ceramide.

[Five days ceftibuten versus 10 days penicillin in the treatment of 2099 patients with A-streptococcal tonsillopharyngitis].

Unlabelled: Group A Streptococci have remained sensitive to penicillins and other betalactam antibiotics, e. g. cephalosporins.

Peri-operative myocardial injury in patients undergoing surgery for critical limb ischaemia.

Introduction: Although up to a half of patients undergoing abdominal aortic aneurysm (AAA) repair suffer myocardial injury, as indicated by a rise in cardiac troponin I (cTnI), this is infrequently accompanied by a rise in creatine kinase (CK)-MB fraction or electrocardiogram (ECG) changes. This study compares for the first time peri-operative cTnI, CK-MB and ECG changes in patients undergoing surgery for critical lower limb ischaemia (CLI).

Methods: Twenty-nine patients (20 men, median age 75 [range, 57-95] years) were studied prospectively.

Development and duration of human papillomavirus lesions, after initial infection.

Background: To determine the potential value of human papillomavirus (HPV) vaccines, information concerning the incidence and duration of clinically important lesions is needed.

Methods: A total of 603 female university students were followed for a mean duration of 38.8 months.

A novel approach to the 2-D blind deconvolution problem in medical ultrasound.

The finite frequency bandwidth of ultrasound transducers and the nonnegligible width of transmitted acoustic beams are the most significant factors that limit the resolution of medical ultrasound imaging. Consequently, in order to recover diagnostically important image details, obscured due to the resolution limitations, an image restoration procedure should be applied. The present study addresses the problem of ultrasound image restoration by means of the blind-deconvolution techniques.

Placebo-controlled trials in major depression are necessary and ethically justifiable: how to improve the communication between researchers and ethical committees.

Despite numerous placebo-controlled clinical trials with antidepressants were conducted in humans and a large amount of data was already published in the last two decades, the members of the 4th European Expert Forum on Ethical Evaluation of Placebo-Controlled Studies in Depression were agreed that placebo-controlled trials with antidepressants also in the future are essential. Placebo-controlled studies measure the effect size in a reliable way and establish sensitivity and internal validity. They are scientifically sound and interpretable in terms of efficacy and are, therefore, clinically more relevant than non-placebo-controlled clinical trials.

Prophylactic management of children at risk for recurrent upper respiratory infections: the Preventia I Study.

Background: Given the morbidity and mortality of asthma and the recent dramatic increase in its prevalence, pharmacologic prophylaxis of this disease in children at risk would represent a major medical advance.

Objectives: The Preventia I Study was designed to evaluate the efficacy and long-term safety of loratadine in reducing the number of respiratory infections in children at 24 months. A secondary objective was to investigate the benefit of loratadine treatment in preventing the onset of respiratory exacerbations.

Coagulopathy and hyperfibrinolysis in ruptured abdominal aortic aneurysm repair.

Perioperative hemorrhage is one of the principal causes of death in patients with ruptured abdominal aortic aneurysm (AAA). This study examines perioperative coagulation and fibrinolysis in patients undergoing ruptured AAA repair complicated by coagulopathy. Eight patients (8 men of median age 74, range 69-87, years) who developed clinical and laboratory evidence of coagulopathy during attempted repair of ruptured infrarenal AAA were prospectively studied.

Occurrence of endemic plasmids causing beta-lactam resistance in Enterobacteriaceae in children's university hospital in Munich.

Susceptibility of 62 clinical isolates of Enterobacteriaceae to 15 aminoglycosides, beta-lactams and fluoroquinolones was determined. The isolates originating from 3 intensive care units (neonatal, pediatric, and surgical) and the Department of Infant Internal Medicine of the Children's University Hospital City Center in Munich (Germany) were collected in August 1999, and March and October 2000. Transferability of antibiotic resistance from donors to their E.

Optimal dispersion relations for enhanced electromagnetic power deposition in dissipative slabs.

Broadband analysis of a prototype model associated with electromagnetic waves absorption in a lossy dielectric slab renders a closed-form theoretical prediction of an infinite number of optimal absorption paths in the complex refractive index domain. While for thin slabs (in terms of incident wavelength range) each path corresponds to a lossy Fabry-Perot-type resonance modes of order m=0,1,2,..

Improving motion estimation by accounting for local image distortion.

Cardiac elastography is a useful diagnostic technique for detection of heart function abnormalities, based on analysis of echocardiograms. The analysis of the regional heart motion allows assessing the extent of myocardial ischemia and infarction. In this paper, a new two-stage algorithm for cardiac motion estimation is proposed, where the data is taken from a sequence of 2D echocardiograms.

Compartmentalization of TNF receptor 1 signaling: internalized TNF receptosomes as death signaling vesicles.

The molecular regulation of the recruitment of initial signaling complexes at the TNF-R1 is poorly defined. We demonstrate here that within minutes internalized TNF-R1 (TNF receptosomes) recruits TRADD, FADD, and caspase-8 to establish the "death-inducing signaling complex" (DISC). In addition, we identified the TNF-R1 internalization domain (TRID) required for receptor endocytosis and provide evidence that TNF-R1 internalization, DISC formation, and apoptosis are inseparable events.

Percutaneous transluminal angioplasty for critical limb ischaemia in octogenarians and nonagenarians.

Objective: To determine the early and late outcome of percutaneous transluminal angioplasty (PTA) for critical limb ischaemia (CLI) in patients aged 80 years and over.

Methods: Retrospective case note review of all patients aged 80 years and over who underwent attempted PTA for CLI between 1st January 1999 and 31st December 2000. Minimum follow-up was 12 months with a maximum of 42 months.

Parameter optimization of pulse compression in ultrasound imaging systems with coded excitation.

A linear array imaging system with coded excitation is considered, where the proposed excitation/compression scheme maximizes the signal-to-noise ratio (SNR) and minimizes sidelobes at the output of the compression filter. A pulse with linear frequency modulation (LFM) is used for coded excitation. The excitation/compression scheme is based on the fast digital mismatched filtering.

Ultrasound attenuation by encapsulated microbubbles: time and pressure effects.

Ultrasound (US) contrast agents (UCA) consist of artificial encapsulated microbubbles filled with low-diffusivity gas. This study evaluated, both experimentally and theoretically, the behavior of a cloud of encapsulated microbubbles while the surrounding pressure was modified within the physiological range. The theoretical analysis included calculation of US attenuation caused by a bubble cloud.

The combined effect of nonlinear filtration and window size on the accuracy of tissue displacement estimation using detected echo signals.

In cardiac elastography, the regional strain and strain rate imaging is based on displacement estimation of tissue sections within the heart muscle carried out with various block-matching techniques (cross-correlation, sum of absolute differences, sum of squared differences, etc.). The accuracy of these techniques depends on a combination of ultrasonic imaging parameters such as ultrasonic frequency of interrogation, signal-to-noise ratio, size of a kernel used in a block-matching algorithm, type of data and speckle decorrelation.

Necrolytic migratory erythema: case report and clinical review.

Background: Necrolytic Migratory Erythema (NME) is a rarely encountered dermatologic condition. It is the characteristic feature of a paraneoplastic syndrome associated with neuroendocrine pancreatic tumors. A case of NME initially diagnosed and treated as psoriasis is reviewed.

Phase unwrapping for 2-D blind deconvolution of ultrasound images.

In most approaches to the problem of two-dimensional homomorphic deconvolution of ultrasound images, the estimation of a corresponding point-spread function (PSF) is necessarily the first stage in the process of image restoration. This estimation is usually performed in the Fourier domain by either successive or simultaneous estimation of the amplitude and phase of the Fourier transform (FT) of the PSE This paper addresses the problem of recovering the FT-phase of the PSF, which is an important reconstruction problem by itself. The purpose of this paper is twofold.