177,024 research outputs found

    Title: Necrotizing Fasciitis: classification, diagnosis and management

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    Necrotizing fasciitis (NF), a life-threatening rare infection of the soft tissues, is a medical and surgical emergency. It is characterized by subtle, rapid onset of spreading inflammation and necrosis starting from the fascia, muscles, and subcutaneous fat, with subsequent necrosis of the overlying skin. Once suspected, immediate and extensive radical debridement of necrotic tissues is mandatory. Appropriate antibiotics and intensive general support avoid massive systemic diffusion of the infective process and are the key for successful treatment. However, early diagnosis is missed or delayed in 85% to 100% of cases in large published series: because of the lack of specific clinical features in the initial stage of the disease, it is often underestimated or confused with cellulitis or abscess. Mortality rates are still high and have shown no tendency to decrease in the last 100 years. Unfortunately, the prevalence of the disease is such that physicians rarely become sufficiently confident with NF to be able to proceed with rapid diagnosis and management. This review covers the literature published in MEDLINE in the period 1970 to December 31, 2010. Particular attention is given to the clinical and laboratory elements to be considered for diagnosis. A wide variety of diagnostic tools have been described to facilitate and hasten the diagnosis of NF, but the most important tool for early diagnosis still remains a high index of clinical suspicion

    Appropriate Similarity Measures for Author Cocitation Analysis

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    We provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis

    "Closing the R&D Gap, Evaluating the Sources of R&D Spending"

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    Both spending and tax policies have been implemented in the United States with the goal of stimulating private sector research and development (R&D). Karier questions whether current R&D policy, especially the research and experimentation tax credit, can contribute to closing the gap between nondefense expenditures on R&D in the United States and such expenditures in other countries, such as Japan and Germany. He also explores possible changes to our current R&D policy to make it more effective.

    Going Beyond Counting First Authors in Author Co-citation Analysis

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    The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed

    Cutaneous manifestations of Scedosporium apiospermum in an immunosuppressed patient

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    Scedosporium apiospermum is a ubiquitous fungus of the soil and polluted water responsible for cutaneous and disseminated infection. It is identified as the common cause of mycetoma after trauma in immunocompetent patient and it is recognized as one of the medically important opportunistic fungi causing life-threatening infections in immunosuppressed patients. Cutaneous involvement lacks pathognomonic features that would make an early diagnosis possible. Presentations range from erythematous lesions, abscesses, nodules with purulent discharge to skin plaques, nodules, scaly, crusted surface, granulomatous lesions without signs of infection. A case of deep cutaneous mycosis mimicking a skin cancer is described. The patient was initially treated for an immunosuppressive therapy-related neoplasm. Afterwards the correct histopathological diagnosis was performed, and the patient underwent the proper long-term antifungal treatment. The review of 38 cases collected from the literature underlines the variability of clinical presentations of cutaneous Scedosporium apiospermum. Healthcare providers awareness of clinical aspects and presentation of Scedosporium apiospermum infections and the knowledge of the best treatment options would prevent treatment delay and can be life-saving in immunocompromised patients. The association of early surgical debridement and specific long-term antifungal therapy (based on intraoperative microbiological specimens) offers the best chance of healing, avoiding the risk of dissemination or local recurrence

    Autologous injectable dermis: a clinical and histological study.

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    BACKGROUND: : No perfect solution yet exists for dermal fillers. The authors hypothesized that autologous dermis can be processed in an operator-friendly manner and adopted in selected patients as a filler, following the principle of replacing "like with like." METHODS: : The authors designed a prototype "cutting chamber" to morsel dermis into an injectable form. Autologous injectable dermis grafting was performed in 16 patients who underwent lip or labionasal fold correction concomitant with abdominoplasty or cesarean scar correction; patient dermis was used for the donor graft. Furthermore, injectable dermis grafting was performed in the subcutaneous tissue of three patients undergoing multistage reconstructive procedures for obesity. The grafts were harvested and examined histologically at 3, 7, and 12 months. RESULTS: : Dermis processing and injection proved feasible with limited effort. All 16 patients presented good volume maintenance by 12 months. Two reported transient palpable firmness for the first 6 months, which subsequently resolved. Histological examination of processed and injected dermis showed volume maintenance over time, effective revascularization of the mass, and structural reorganization with collagen bundles and nested fibroblasts reminiscent of reticular dermis. A transient inflammatory reaction was observed, consistent with the expected healing events. CONCLUSIONS: : Use of autologous dermis as a filler substance for both aesthetic and reconstructive procedures appears to be a feasible option. It could be advised for patients requiring filler correction who undergo concomitant procedures involving excision of potential donor dermis

    Letter from R. R. Zellick, Assistant Trust Officer, Anglo California National Bank of San Francisco, to Joseph R. Goodman, October 2, 1942

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    Letter from R. R. Zellick, Assistant Trust Officer at The Anglo California National Bank of San Francisco, to Joseph R. Goodman, regarding property owned by Dave Tatsuno. Zellick mentions a dispute between current tenants and Tatsuno, and that Tatsuno has asked Goodman to help locate trustworthy tenants.Personal correspondence, organizational records, government documents, publications, and other papers created or collected by Joseph R. Goodman documenting the forced removal and incarceration of Japanese Americans during World War II, as well as organized resistance to incarceration. Included in the collection are records of the Japanese Young Men's Christian Association and the Japanese American Citizens' League in San Francisco, including papers of the Japanese YMCA's executive secretary Lincoln Kanai; Sakai family papers; Goodman's correspondence to and from Japanese American incarcerees, organizations opposing forced removal and incarceration of Japanese Americans, the War Relocation Authority, and others; publications, photographs, and ephemera from the Topaz Relocation Center, where Goodman taught high school; War Relocation Authority records and publications; and newspaper clippings, pamphlets, and reports about forced removal and incarceration created by various government, religious, and civic organizations, in California and nationwide
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