NPWT has been used on many complex traumatic wounds. Potential mechanisms of action include angiogenesis, increased blood flow, and decreased interstitial fluid. This ongoing randomized study has demonstrated decreased drainage and improved wound healing following both hematomas and severe fractures.
Sternal wound infection is a life-threatening complication after cardiac surgery associated with high morbidity and mortality. Past treatment options have included closed suction and continuous irrigation. Current paradigms in the management of sternal wound infection include surgical debridement, vacuum-assisted closure therapy, flap coverage, and sternal plating. We provide a general overview of sternal wound infection and treatment options for the plastic surgeon.
Enantioselective hydrolysis of oral racemic methylphenidate (dl-MPH) by carboxylesterase 1 (CES1) limits the absolute bioavailability of the pharmacologically active d-MPH isomer to approximately 30% and that of the inactive l-MPH to only 1-2%. Coadministration of dl-MPH with ethanol results in elevated d-MPH plasma concentrations accompanied by CES1-mediated enantioselective transesterification of l-MPH to l-ethylphenidate (EPH). The present study tested the hypothesis that administration of the pure isomer dexmethylphenidate (d-MPH) will overcome the influence of ethanol on d-MPH absorption by eliminating competitive CES1-mediated presystemic metabolism of l-MPH to l-EPH. Twenty-four healthy volunteers received dl-MPH (0.3 mg/kg) or d-MPH (0.15 mg/kg), with or without ethanol (0.6 g/kg). During the absorption phase of dl-MPH, concomitant ethanol significantly elevated d-MPH plasma concentrations (44-99%; P < 0.005). Furthermore, immediately following the ethanol drink the subjective effects of "high," "good," "like," "stimulated," and overall "effect" were significantly potentiated (P £ 0.01). Plasma l-EPH concentrations exceeded those of l-MPH. Ethanol combined with pure d-MPH did not elevate plasma d-MPH concentrations during the absorption phase, and the ethanolinduced potentiation of subjective effects was delayed relative to dl-MPH-ethanol. These findings are consistent with l-MPH competitively inhibiting presystemic CES1 metabolism of d-MPH. Ethanol increased the d-MPH area under the curve (AUC) 0-inf by 21% following dl-MPH (P < 0.001) and 14% for d-MPH (P = 0.001). In men receiving d-MPH-ethanol, the d-MPH absorption partial AUC 0.5-2 hours was 2.1 times greater and the time to maximum concentration (T max ) occurred 1.1 hours earlier than in women, consistent with an increased rate of d-MPH absorption reducing hepatic extraction. More rapid absorption of d-MPH carries implications for increased abuse liability.
HE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION has enjoyed an illustrious 116-year history as a peerreviewed medical journal dedicated to the science and art of medicine and the betterment of the public health. When George D. Lundberg, MD, editor of JAMA, was removed from his position on January 15, 1999, there was concern within the medical and scientific publishing communities that his dismissal was a challenge to JAMA's editorial freedom and integrity. To reaffirm the American Medical Association's (AMA's) commitment to the integrity of THE JOURNAL, to maintain JAMA's editorial independence, to protect THE JOURNAL's integrity, and to assist in selecting a new editor, 1 the AMA assembled a search committee and announced its members on January 27, 1999. The committee is chaired by Roger N. Rosenberg, MD, Zale Distinguished Chair in Neurology and professor of neurology at the University of Texas Southwestern Medical Center in Dallas and editor of the Archives of Neurology.
Objective: This study assessed affordability of care in a diverse sample of Floridians aged ≥ 65 to ascertain concerns about health care costs. Methods: We surveyed 170 adults (40.6% white, 27.6% black, and 31.8% Hispanic) and conducted three race/ethnic-stratified focus groups ( n = 27). Results: Most participants had Medicare (97.1%). Among whites, 11.6% reported problems paying medical bills in the past 12 months versus 14.9% of blacks and 24.1% of Hispanics. In addition, 13% of whites, 19.2% of blacks, and 20.4% of Hispanics reported not getting needed prescription drugs because of costs. The most frequently identified concerns from the focus groups were the cost of prescription drugs, out-of-pocket expenses, and medical billing. Concerns about medical billing included understanding bills, transparency, timely postings, and uncertainty about who to contact about problems. Discussion: Our findings suggest that practices that help older adults effectively manage medical bills and costs may alleviate their concerns and guard against financial burdens.
Aims/Objectives To promote the importance of HIV testing, and to see if the outreach was successful in targeting a less tested population of MSM. Methods The promotion was determined by the "opportunities to view" key messages. Individuals tested in the bar completed a form collecting age, gender, orientation, time since last HIV test, unprotected anal (UAI) or vaginal sex. Similar information was collected from 100 patients walking into the generic service for an HIV test on the same day. Age groups <25, 26e30, 31e39, >40 were chosen. Results There were 890 000 opportunities to view the key messages. 467 individuals tested in the gay bar, but only 441 forms were sufficiently complete for this analysis. MSM in the gay bar were younger than the clinic (54% and 44% respectively <30; p¼0.027), and more likely to have never tested (18% and 6%; p¼0.007). In the gay bar, only 9/89 (10%) of MSM aged 31e39 had never tested, only 2/9 (22%) reporting UAI. This contrasted to the 15%e24% of 54 MSM in the other age groups that had never tested, 60%e77% of whom reported UAI. Only five MSM attending clinic had never tested, 4 (80%) of whom were <25 (see abstract P7 table 1). Discussion As well as promoting the benefits of regular testing to the wider gay community, the event was successful in reaching a less tested, but nonetheless high risk population of MSM, in particular, those <25.
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