9 research outputs found
Allergic Dermatitis Due to Topical Antibiotics
In this report we present a case of allergic dermatitis from chronic use of antibiotic ointment mistakenly diagnosed as a localized finger infection
Allergic Dermatitis due to Topical Antibiotics
In this report we present a case of allergic dermatitis from chronic use of antibiotic ointment mistakenly diagnosed as a localized finger infection. [West J Emerg Med. 2012;13(4):380–382.
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Allergic Dermatitis due to Topical Antibiotics
In this report we present a case of allergic dermatitis from chronic use of antibiotic ointment mistakenly diagnosed as a localized finger infection. [West J Emerg Med. 2012;13(4):380–382.
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Range of motion measurements in hand surgery: should they be used for assessing outcomes?
PurposeThe purpose of the study was to assess how context influences range of motion measurements in hand surgery.MethodsOne hundred seventy-five consecutive patients presenting to a hand surgery clinic were evaluated over 7 sessions. Passive and active motion were measured with a goniometer and by visual estimation. The affected joint was measured by 3 different examiners-one hand surgeon and 2 research assistants (RAs). Measurements by the RAs were performed under the pretense of imaginary project titles and purposes.ResultsRange of motion measurements were easily influenced. As the invented project's purpose became more specific and dependent on physician intervention, the bias became more pronounced. Measurements performed under construed project titles that promoted surgical intervention garnered outcomes that supported surgery (P < 0.01). Conversely, when the manufactured study's intent was to find support in conservative treatment, this outcome could also be generated (P < 0.01).DiscussionRange of motion measurements can easily be influenced by the context of the study, even in seemingly blinded examiners. Reliable range of motion measurements can only be made when the examiner has no knowledge of the study's intent
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Does the gatekeeper model work in hand surgery?
BackgroundMost managed care plans use a physician "gatekeeper" to control referrals to hand surgeons. The appropriateness of this model for upper extremity complaints has never been challenged. The purpose of this study was to evaluate the prior management of patients with elective hand disorders who present to a hand surgery clinic.MethodsAll patients presenting to a tertiary, academic medical center for a new-patient hand surgery evaluation from February 3, 2011, to June 15, 2011, were prospectively enrolled. Patients were evaluated for prior provider, diagnosis, treatment, and complications. Actual diagnosis, recommended workup, and appropriate treatment were determined independently by two experienced hand examiners. Traumatic injuries and surgeon disagreements in diagnosis and treatment were excluded, leaving 125 patients.ResultsNinety-eight percent of patients had been evaluated by a primary care provider. Overall, the correct diagnosis was established 34 percent of the time. Nerve compression syndromes were diagnosed with the greatest accuracy (64 percent), whereas stenosing tenosynovitis was diagnosed correctly only 15 percent of the time. Before presentation, 74 percent of patients had undergone a study or intervention. On review, 70 percent of studies/interventions were deemed unnecessary. Advanced imaging was unwarranted in 90 percent of patients who received it. Seventeen percent of patients experienced a complication. Most (67 percent) were caused by a delay in diagnosis, whereas 33 percent resulted from an intervention.ConclusionsHealth care providers less familiar with an examination of the hand often misdiagnose and mistreat common problems. A referral system may not be the most efficient means of delivering care to patients with elective hand maladies
Clonal CD8<sup>+</sup> T Cell Persistence and Variable Gene Usage Bias in a Human Transplanted Hand
<div><p>Immune prophylaxis and treatment of transplanted tissue rejection act indiscriminately, risking serious infections and malignancies. Although animal data suggest that cellular immune responses causing rejection may be rather narrow and predictable based on genetic background, there are only limited data regarding the clonal breadth of anti-donor responses in humans after allogeneic organ transplantation. We evaluated the graft-infiltrating CD8<sup>+</sup> T lymphocytes in skin punch biopsies of a transplanted hand over 178 days. Profiling of T cell receptor (TCR) variable gene usage and size distribution of the infiltrating cells revealed marked skewing of the TCR repertoire indicating oligoclonality, but relatively normal distributions in the blood. Although sampling limitation prevented complete assessment of the TCR repertoire, sequencing further identified 11 TCR clonal expansions that persisted through varying degrees of clinical rejection and immunosuppressive therapy. These 11 clones were limited to three TCR beta chain variable (BV) gene families. Overall, these data indicate significant oligoclonality and likely restricted BV gene usage of alloreactive CD8<sup>+</sup> T lymphocytes, and suggest that changes in rejection status are more due to varying regulation of their activity or number rather than shifts in the clonal populations in the transplanted organ. Given that controlled animal models produce predictable BV usage in T lymphocytes mediating rejection, understanding the determinants of TCR gene usage associated with rejection in humans may have application in specifically targeted immunotherapy.</p></div