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An angiokeratoma is a benign vascular lesion that appears as one or more red to black papules with a verrucous surface. Histologically, it is defined by ectatic, thin-walled vessels in the papillary dermis, acanthosis with elongated rete ridges, and compact hyperkeratosis. Solitary angiokeratoma is one of five defined subtypes of angiokeratoma. We report the case of an 18-year-old woman with a “wart” that had been present for many years. After treatment with several over-the-counter wart therapies, several rounds of paring plus cryotherapy, and Candida antigen injections failed, a shave biopsy was taken to remove the lesion, and histopathologic examination was consistent with an angiokeratoma. This case demonstrates the importance of considering angiokeratoma in the differential diagnosis of a wart, particularly one recalcitrant to treatment.

ObjectivesInforming research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.DesignIn the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.SettingUK stroke services.Participants3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.ResultsOf those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.ConclusionIt is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration numberISRCTN83290762; Post-results.

To discuss technical modifications specific to the cleft Le Fort I osteotomy that improve mobilization and demonstrate the stability of the maxilla at the Le Fort I level in a cohort of patients with cleft palate (with or without cleft lip) who underwent traditional maxillary advancement.This was a retrospective evaluation of patients with cleft palate (+/- cleft lip) who underwent orthognathic surgery for management of skeletal malocclusions. All study subjects had a Le Fort I osteotomy +/- bilateral mandibular sagittal split osteotomies. The cleft Le Fort I osteotomy technique is modified to extensively release fibrous tissue and scar from the posterior maxilla, including around the tuberosity, along the posterior maxillary sinus wall, and circumferentially around the descending palatine canal. Maxillary position was assessed using angular and linear measurements pre-operatively (T0), immediately post-operatively (T1), and at 1-year post-operatively (T2). Descriptive and bivariate statistics were computed; a P 0.05 was considered significant.Twenty-eight patients with cleft palate (with or without cleft lip) were included. The sample's mean age was 18.9 ± 1.4 years and included 11 females. The majority of subjects (64.3%) underwent bimaxillary surgery; eight subjects (28.6%) had segmental maxillary surgery and 14 subjects (50%) had simultaneous maxillary interpositional bone grafting. The mean maxillary sagittal advancement was 6.1 mm (range: 0-10 mm). At 1-year post-operatively, the absolute change in SNA was 0.7 ± 0.9 degrees; the absolute change in maxillary sagittal position was 0.8 ± 0.6 mm. There was no association between the magnitude of advancement and the magnitude of position change (P = 0.86). Stability was not influenced by segmental surgery, bone grafting, or bimaxillary surgery (P 0.33).Using a modified technique with extensive release of posterior scar and graduated intra-operative traction, maxillary advancement of up to 10 mm can be performed in patients with cleft palate (± cleft lip) with sagittal relapse of1 mm at 1-year post-operatively.

Aim Satisfactory increments may be achieved in refractory patients with platelets that are antigen negative for corresponding HLA antibody. However, no HLA antibody test or cutoff is universally used. Our small study sought to identify an appropriate single antigen bead assay (SAB) and Mean Fluorescent Intensity (MFI) cutoff to select HLA mismatched platelets in lieu of platelet crossmatch (PLT XM). Methods HLA sensitized patient sera (n = 17; CPRA 24–100%, median 93%) were tested by One Lambda™ Class I IgG-SAB and C1q-SAB and Immucor™ C3d-SAB, and PLT XM against 8 Class I typed platelets. Cumulative MFI for donor specific antibodies (DSA) in 36 patient-donor pairs were calculated. The vendor’s recommended cutoff for C3d-SAB, 500 MFI for C1q-SAB and 3000, 5000 and 10,000 MFI for IgG-SAB were used to assign an expected result to compare with the observed PLT XM result. MFI values from IgG-SAB negative, PLT XM positive (presumed false negative) pairs were replaced with MFI values from 1:10 diluted serum to correct for complement interference (Mod IgG-SAB). Results were stratified by MFI and sensitivity and specificity were calculated. Results No SAB was 100% concordant with PLT XM. Two positive PLT XMs were likely due to ABO incompatibility. Two negative PLT XMs occurred in the presence of moderately strong B44 DSA. C1q-SAB compares favorably with PLT XM. C3d-SAB has the highest specificity, but lowest sensitivity. IgG- and Mod IgG-SAB (3000 MFI) have excellent sensitivity but poor specificity. When Mod IgG-SAB cutoff is raised to 5000 MFI or 10,000 MFI, specificity increases but sensitivity decreases. Mod IgG-SAB (5000 MFI) sensitivity is comparable to C1q-SAB and specificity is improved when B44 DSA Conclusions C1q-SAB is reported to correlate with acceptable platelet increments and correlates well with PLT XM in our study. Mod IgG-SAB (5000 MFI) that ignores anti-B44 DSA

Ultrasonic aspirators are commonly used to resect brain tumours because they allow safe, rapid and accurate removal of diseased tissue. Since ultrasonic aspirators generate a spray of aerosolized irrigating fluid around the instrument tip, we questioned whether this spray might contain viable tumours cells that could contribute to intraoperative spread of tumour fragments. To test this hypothesis, we collected the spray produced during the resection of nine brain tumours with an ultrasonic aspirator and semi-quantitatively analysed it for tumour presence. The aerosolized irrigation fluid was found to contain intact tumour cells or clumps of tumour cells in all nine instances, and there was a trend of increasing tumour cell dispersion with increasing ultrasonic aspiration times. Further examination is required to determine if this intraoperative dispersion of apparently viable tumour fragments contributes to local neoplasm recurrence.

Background Flexible intramedullary nailing (IMN) has become a popular technique for the management of unstable or open forearm fractures. Recent publications have suggested an increased incidence of delayed union and poor outcomes in older children and adolescents. The objective of this study was to review forearm fractures treated with IMN, comparing the rate of complications and outcomes between the 2 age groups. Our hypothesis was that IMN is an effective technique with a similar rate of complications in both age groups. Methods An Institutional Review Board-approved retrospective review was conducted of pediatric forearm fractures treated from 1998 to 2008 at a single institution. Over the study time period, 4161 pediatric forearm fractures were managed nonoperatively (92%) and 353 were treated operatively with plate, cross-pin, or intramedullary fixation (8%). Patients with inadequate follow-up, cross-pin, or plate fixation were excluded. Medical records were reviewed for indications and complications. Complications were graded with a modification of the Clavien-Dindo classification. Outcomes were judged by a new grading system. Results A total of 205 forearm fractures treated with IMN in 203 patients were identified. The mean age was 9.7 years (range, 1.7 to 16.2 y) and mean follow-up was 42 weeks. Operative indications were failure of closed treatment in 165 (80%) and open fracture in 40 (20%). Mean time from injury to IMN was 5.9 days (range, 0 to 25 d). Single bone IMN was performed in 40 of 185 both bone fractures (26%); there were 20 single-bone forearm fractures treated with IMN. Open reduction was required in 61/165 (37%) of closed fractures. Asymptomatic delayed union (grade 1 complication) was observed in 9 fractures (4%). More severe complications were noted in 17% (grade 2 to 4 complications). Postoperative compartment syndrome occurred in 3 isolated forearm fractures with a significant younger mean age (6.0 vs. 10 y, P=0.031). Overall, complications were significantly more frequent in children older than 10 years of age (25/101) as compared with younger children (13/104, P=0.031). In particular, delayed union was more common in children over the age of 10 years (9/101 vs. 1/104, OR=9.99, P=0.009). Outcomes were good or excellent in 91% of fractures. There was no statistical association of patient age with a fair or poor outcome. Conclusions IMN is an effective technique for pediatric forearm fractures with good to excellent outcomes in 91%. Complications are not infrequent with this technique, with complications of grade 2 to 4 severity in 17%. There was a 2-fold increase in the rate of complications in children over the age of 10 years. Compartment syndrome was more common in younger children. Patients and families should be counseled about the risks preoperatively.

This paper compares the abilities of similarity mapping and eigenimaging for the purpose of identifying (segmenting) different image structures in dynamic MR imaging. As an illustrative example a case of dynamic images with a low grade astrocytoma was chosen. It was found that the similarity mapping was more successful than eigenimaging in determining the extent and position of a low grade astrocytoma. Also, similarity mapping was able to identify another region with a different and uncorrelated temporal pattern that was later diagnosed as a cyst.

Examination of faecal egg counts in horses and ponies has shown that after treatment with fenbendazole at dose levels of 7.5, 45 and 60 mg/kg, faeces remained free from strongyle eggs for periods of 6 to 18 weeks. The significance of these results is discussed in relation to routine anthelmintic treatment of horses. In particular, the activity of fenbendazole against mucosal stages of strongyle parasites allows for treatment to be recommended at less frequent intervals than when using other anthelmintics.

In October 1987, the new Part I of the MRCPsych examination was introduced. One aim of the College in changing the Preliminary Test, which had been introduced in 1971, was to create a more appropriate screening procedure so that those who are unsuited to psychiatry can receive career advice at an early stage in their career. To this end there has been a shift in emphasis away from the basic sciences towards clinical psychiatry. The major change in format of the examination is the removal of the essay paper and the introduction of a clinical examination. In order to qualify to enter for the new Part I examination, candidates have to submit sponsor forms signed by a consultant for whom they have worked and by their clinical tutor. The sponsors are asked to certify that the candidate has been able to attend an appropriate course of instruction and has received training in interview skills.

SUMMARY The efficacy of fenbendazole against immature stages of Trichonema spp., Strongylus vulgaris and Strongylus edentatus was evaluated. Naturally infected 6 to 12 month old ponies were given single, oral doses of 0, 15, 30 and 60 mg/kg of body weight. A dose response relationship was noted between increasing dose levels and efficiency against larval trichonemes and migrating stages of S. vulgaris and S. edentatus. Dose levels of 30 mg/kg and higher removed 93 per cent of mucosal stages of Trichonema spp., while doses of 60 mg/kg removed 83 per cent and 89 per cent of the migrating larvae of S. vulgaris and S. edentatus respectively. RESUME On a evalue l'efficacite du fenbendazole sur les stades larvaires de St Vulgaris, St edentatus et Trichonema spp. Des poneys naturellement infectes âges de 6 a 12 mois recurent des doses orales de 15, 30 et 60 mg/kg de poids vif de fenbendazole. L'efficacite sur les stades larvaires parut dependre de la dose administree. Des taux de 30 mg et au dessus detruisirent 93% des larves intra muqueuses de Trichonema tandis que des doses de 60 mg/kg detruisaient 83% des larves migrantes de St vulgaris et 89% des larves migrantes de Str edentatus. ZUSAMMENFASSUNG Die Wirksamkeit von Fenbendazol gegen unreife Stadien von Trichonema spp., Strongylus vulgaris und Strongylus edentatus wurde untersucht. Naturlich infizierte Ponies im Alter zwischen 6 und 12 Monaten erhielten orale Einzeldosen von 0, 15, 30 und 60 mg pro kg Korpergewicht. Eine Beziehung zwischen Dosis und Wirkung gegen Trichonemalarven und Wanderlarven von S. Vulgaris und S. edentatus konnte beobachtet werden. Dosierungen von uber 30 mg/kg vermochten 93% der Schleimhautstadien von Trichonema zu entfernen, wahrend Dosierungen von 60 mg/kg 83 bzw. 89% der Wanderlarven von S. vulgaris und S. edentatus abtoteten.

The most recent branch of holography, acoustical holography employing acoustical radiation, presents a variety of new and highly interesting possible applications: Thus objects can be imaged in a turbid liquid medium (marine research); the technique can be used for non-destructive investigations of the internal structure of objects that are opaque to light (testing of materials) and is possibly also a potential tool for the three-dimensional imaging of biological structures (biomedical diagnosis).

Der jungste Zweig der Holographie, die akustische Holographie unter Verwendung von Schallstrahlung, bietet neue und sehr interessante Anwendungsmoglichkeiten: So lassen sich damit Objekte in einem flussigen, auch truben Medium abbilden (Unterwasserforschung); sie kann zur zerstorungsfreien Untersuchung der auseren Form, aber auch der inneren Struktur lichtundurchlassiger Objekte herangezogen werden (Materialprufung) und ist unter anderem vielleicht ein potentielles Werkzeug zur dreidimensionalen Erfassung biologischer Strukturen (biomedizinische Diagnose).

The efficacy of a fenbendazole divided dose regime against immature stages of Trichonema spp, Strongylus vulgaris and Strongylus edentatus was evaluated. A group of 8 naturally infected 30 to 36-month-old ponies was divided into 2 equal groups on the basis of previous treatment and faecal egg counts, one group being treated with 7.5 mg/kg bwt of fenbendazole daily for 5 days. This treatment regime removed 80 per cent of migrating S vulgaris larvae, 100 per cent of migrating S edentatus larvae and 95 per cent of the mucosal stages of Trichonema spp. In addition, a virtual 100 per cent elimination of adult stages of large and small strongyles was obtained.