Painful tumors of the skin present as dermal or subcutaneous nodules. They can originate from several sources: adipose tissue, cartilage degeneration, deposition of bone or calcium, eccrine glands, ...fibrous tissue, infiltration of benign (endometrium) or malignant (metastatic neoplasm) tissue, muscle, nerve, or vascular structures. Although pathologic evaluation of the lesion is necessary to determine the diagnosis, it is possible to make a reasonable differential diagnosis based on knowledge of prior tumors that have appeared as tender lesions. Two women with painful skin tumors - either osteoma cutis or an organizing thrombus - are described. Based on our clinical experience and review of the literature, 25 painful skin tumors were identified:
hondrodermatitis nodularis helicis,
ngioendotheliomatosis,
eiomyoma,
etastases,
idradenoma,
steoma cutis,
lomus tumor,
ibromyxoma,
eiomyosarcoma,
ccrine angiomatous hamartoma,
ercum's disease,
eizogenic pedal papule,
eurilemmoma,
ngiolipoma,
euroma,
ermatofibroma,
ranular cell tumor,
ndometriosis,
hrombus,
car,
lue rubber bleb nevus,
ngioma,
alcinosis cutis, and
eloid. An acronym - inspired by Charlotte's Web, a book that many children have read - that can be used as a memory aid for recalling the list of painful skin tumors is introduced: "CALM HOG FLED PEN AND GETS BACK".
Multiple skin neoplasms at one site (MUSK IN A NEST), initially referred to as a collision tumor, describes the occurrence of two or more benign or malignant neoplasms that are adjacent or ...intermingled at the same cutaneous site. A mononeoplastic cutaneous tumor refers to a single tumor at any cutaneous site. Two, three, four, five, and six tumors at the same site are described as dineoplastic, trineoplastic, tetraneoplastic, pentaneoplastic, and hexaneoplastic cutaneous tumors, respectively; the prefixes are based on the numerical multiplier used by the International Union of Pure and Applied Chemistry (IUPAC). MUSK IN A NEST can be classified based upon their mechanism of pathogenesis-either being composed of mixed clones of cells (clonalium, which has three subtypes: collision, colonization, and combination) or the same clone of cells that has undergone clonal evolution (clonalidem, which has one subtype: biphenotypic). Basal cell carcinoma (BCC)-associated MUSK IN A NEST can be observed with either benign tumors, malignant tumors, or both. Nevi and seborrheic keratoses are the most common benign tumors associated with BCC; melanoma in situ and invasive melanoma are the most commonly reported malignant tumors associated with BCC. The definitive etiology of BCC-associated MUSK IN A NEST remains to be established-whether the development of the BCC at that site occurs as a direct or indirect consequence of the coexisting neoplasm or whether the occurrence of the BCC and the other neoplasm is merely the result of a coincidental juxtaposition of the tumors.
We report on a high-precision calculation of the Bhabha process in quantum electrodynamics, of interest for precise luminosity determination of electron–positron colliders involved in
R measurements ...in the region of hadronic resonances. The calculation is based on the matching of exact next-to-leading order corrections with a parton shower algorithm. The accuracy of the approach is demonstrated in comparison with existing independent calculations and through a detailed analysis of the main components of theoretical uncertainty, including two-loop corrections, hadronic vacuum polarization and light pair contributions. The calculation is implemented in an improved version of the event generator
BABAYAGA with a theoretical accuracy of the order of 0.1%. The generator is now available for high-precision simulations of the Bhabha process at flavour factories.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Among 547 preterm infants of < or = 34 weeks gestation born between 1987 and 1991, 8 children (1.46%) developed severe progressive and bilateral sensorineural hearing loss. Perinatal risk factors of ...infants with hearing loss were compared with those of two control groups matched for gestation and birth weight and for perinatal complications. Our observations demonstrated an association of hearing loss with a higher incidence of perinatal complications. Ototoxicity appeared closely related to a prolonged administration and higher total dose of ototoxic drugs, particularly aminoglycosides and furosemide. Finally, we strongly recommend to prospectively and regularly perform audiologic assessment in sick preterm children as hearing loss is of delayed onset and in most cases bilateral and severe.
Eleven newborns admitted consecutively to the neonatal unit with respiratory failure and severe persistent pulmonary hypertension (PPHN) were included in a clinical trial to assess the efficacy of ...magnesium sulphate (MgSO4) in the treatment of PPHN. A loading dose of 200 mg/kg MgSO4 was given over 20 minutes, followed by a continuous infusion of 20-150 mg/kg/hour to obtain a magnesium blood concentration between 3.5 and 5.5 mmol/l. Mean (SD) duration of treatment was 75.5 (19.8) hours. No other vasodilatory drug was administered before or during the treatment and patients were not hyperventilated. Mean (SEM) PaO2 values significantly increased from 42.6 (8.8) before treatment to 70.3 (24.1) mm Hg after 24 hours, with no change in pH or PCO2. Oxygen index and alveolar-arterial oxygen gradient (A-aDO2) were significantly lower after 24 hours; respectively, 46.8 (15.2) to 28.0 (9.0) and 624.3 (11.3) to 590 (58) mm Hg. Mean airway pressure could be significantly reduced from 19.5 (3.1) to 13.9 (3.9) cm H2O after 72 hours. Mean ventilatory time support was 131 hours and mean total oxygen dependency 10 days. No systemic hypotension nor any other adverse effect were noted. All infants survived and the neurodevelopmental assessment was normal at 6 and 12 months of age. It is concluded that magnesium sulphate is a non-aggressive and low-cost treatment of short duration which is easy to apply. It may have a role in the various treatment of PPHN.
The relative role of perinatal factors (birthweight, gestational age, gender, asphyxia, mechanical ventilation and cerebral lesions), developmental factors (neuromotor development during the first 18 ...months of life) and environmental factors (socio-economic status and bilingualism) on cognitive abilities was evaluated in a cohort of preterm children who had been prospectively examined for haemorrhage (PVH) and periventricular leucomalacia (PVL) and followed-up to 5 years of age. Standardised neurological examinations and development assessment including tests of cognitive function were carried out. Major impairments could be ascribed to the presence of large PVL changes. Among the 226 children without major impairment, the overall incidence of neuropsychological anomalies (neuromotor, language, visual, auditory and behaviour anomalies) was 46.5% and did not differ within ultrasound groups (normal scans, PVH and small PVL). However, children with small changes of PVL presented more abnormal neuromotor development within the first 18 months of life and had more complex neuropsychological anomalies at 5 years. The multiple regression analysis (General Intellectual Index (GII) predicted = 113.7 − coefficient × social class − 8.5 × bilingualism − 5.5 × dystonia + 1.4 × gestational age + 8 × mechanical ventilation) showed that socioeconomic status was the most important factor affecting the General Intellectual Index (GII). The contribution of sex and cerebral lesions was not significant. As children grew-up, environmental factors seemed to overcome perinatal factors.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Psychomental stress is a major source of illness and reduced productivity. Data objectifying physiological stress responses are scarce. We studied salivary cortisol levels in a highly stressful ...environment, the pediatric critical care unit. The aim was to identify targets for organizational changes, to implement these changes and to assess their impact on cortisol levels.
Repeated measurements observational cohort study (before and after intervention).
84 nurses working in two independent teams (A and B) in a 19 bed pediatric intensive care unit. Between study periods team A experienced a major exchange of experienced staff while the turnover rate in team B remained average.
Salivary cortisol samples were collected every 2 h and after stressful events. Nurses in study period I showed elevated cortisol levels at the beginning of the late shift, interpreted as an anticipatory stress reaction. To ease conditions during the early part of the late shift (conflicting tasks, noise and crowding), we postponed the afternoon ward round, limited non-urgent procedures and introduced a change in visiting hours. The early shift, which was not affected by the intervention, served as control.
Both crude and adjusted analysis revealed a decrease of cortisol levels at the beginning of the late shift in team B (p = 0.0009), but not in team A (p = 0.464). The control situation showed no difference between teams and study periods.
We demonstrated reduced cortisol secretions in one team following organizational changes, which was probably overridden by the disruption of social coherence in the second team.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In a crossover trial left ventricular output (LVO), cerebral blood flow velocity (CBFV), and resistance index (RI) of the anterior cerebral artery were compared using Doppler ultrasonography, in ...eight preterm infants with respiratory distress syndrome (RDS) during conventional mechanical ventilation and high frequency oscillation. LVO was 14% to 18% lower with high frequency oscillation. There were no significant changes in CBFV. On the first day of life there was a trend towards lower RI on high frequency oscillation; the fall in LVO on high frequency oscillation was not related to lung hyperinflation. Changes in ventilation type (from conventional mechanical ventilation to high frequency oscillation, or vice versa) can induce significant LVO changes in preterm infants with RDS.
Immune complex formation causes underdetection of p24 antigen in human immunodeficiencyvirus(HIV)infection.Brieflyboilingdilutedplasma releasesallcomplexedantigen, which can then be measured by some ...commercial assays. In a retrospective pediatric cohort study, the specificity of this procedure in 390 uninfected samples was 96.9% after initial testing and 100% after neutralization. Sensitivity among 125 postnatal infected samples was, at a detection of 2 pg/ml., 96.0% (97% neutralizable) compared with 47.7% for regular antigen (76% neutralizable), 96% for polymerase chain reaction, and 77% for viral culture. The high sensitivity and specificity of heat-denatured antigen was confirmed by prospectively testing 113 additional samples.Quantitativeanalysisofsamplesfrominfectedinfants showedlowlevelsofp24 antigen in 29% of cord blood sera, a postnatal increase to levels that were during the first 6 months of life inversely associated with survival, and persistence of antigenemia thereafter independent of clinical status. Prevalence and antigen levels were significantly lower in mothers. The persistent antigenemia in children indicates that their immune systems cannot restrict HIV expression as efficiently as those of adults.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
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