We successfully treated a patient with palmoplantar pustulosis, with a combined formulation of hainosankyuto and maobushisaishinto. The patient was a 64-year-old female, who had frequently occurring pustulae of about 2 mm in size on her palms and soles, from about May 2000. These pustulae became a crust over time, and the skin peeled off and healed. However, pustulae would persist again every two weeks. We diagnosed this as palmoplantar pustulosis and administered hainosankyuto, but with limited results, whereupon we added maobushisaishinto. As a result of this combined hainosankyuto and maobushisaishinto formulation, our patient with palmoplantar pustulosis recovered significantly after 4 weeks.
Patients ; week ; Treated with ; Combined ; SIZES

AIM: To study the clinical features, histology and immunohistochemical properties of gastrointestinal stromal tumours (GISTs); and establish any parameters that can help prognosticate the malignant potential. METHODS: Twenty-six patients with GISTs who were seen in Sultanah Aminah Hospital Johor, Malaysia from 1999 to 2003 were selected for study. Patient, clinical characteristics and outcome based on surgical records were analysed. Tumour variables (tumour size, cellularity, mitotic count, necrosis and haemorrhage) were compared between very low to low risk groups and intermediate to high risk groups. The immunohistochemical properties of GISTs were also studied. RESULTS: Patients with GISTs presented mainly with pain, palpable mass or gastrointestinal tract bleeding. The tumours were seen in stomach (50%) followed by small intestine (38.5%) and rectum (11.5%). In the period of study, six patients had metastasis, mainly in the liver or peritoneum. Immunoreactivity for CD117, CD34, vimentin, S100, neuron specific enolase, alpha-smooth-muscle-actin and desmin were observed in 100%, 76.9%, 61.5%, 46.1%, 80.8%, 11.5% and 0% of tumours respectively. The behaviour of GISTs was largely dependent on tumour size and number of mitosis. Necrosis and haemorrhage were seen in tumours with high risk potential.
Gastrointestinal ; Clinical ; Risk ; Hemorrhage ; SIZES

A vascular access catheter has been widely used for hemodialysis patients in an emergency when an arteriovenous shunt get clogged and cannot be reopened or when patients have no arterio-venous fistula. However, it often causes deterioration in activities of daily living (ADLs) and other troubles. Therefore, we place the catheter into the internal jugular vein in the neck to minimize the risk of complications and patients' inconvenience. Nevertheless, free spaces tend to be created between the dressing agent and skin because the articular excursion is wide in the neck. Although the CDC (Centerfor Disease Control and Prevention) guidelines recommended that the dressing tapes should be changed once every seven days, we change the tapes every two or four days to avoid peeling-off. In this study, we examine the difference in fixation ability between two types of tapes;standard size (10×12 cm) and 1/4 cut-size (5×6 cm). Our results showed that there were significant differences in peeling-off area between the two tapes. The smaller-sized tape had better adhesion to the skin so that you could not peel it off easily. Furthermore, the smaller one stuck fast to the catheter and needed less replacement. Consequently, the skins seemed to be more protected.
Catheter ; Blood vascular ; SIZES ; Access ; Fixation - action

In the recent years, two trends emerged in the clinical laboratory: the miniaturisation of equipments to provide point-of-care testing (POCT) and a concentration of laboratories through mergers and acquisitions. New technology has expanded both opportunities. POCT provides the benefit of a convenient test where it is needed, i.e. near the patient. For companies, it is easier and cheaper to develop such tests, since technical requirements are somewhat less stringent, being an interesting area for start-ups. Nanotechnology is one of the most fascinating technical advances, with some advocating a US$1 trillion market-size for it by 2015. Laboratory tests and biomaterials will probably be greatly influenced by it, with new approaches for molecular diagnosis, with tests that can target both DNA and proteins in a process that eliminates PCR and allows multiplex analysis. On the other hand, there is a strong trend towards the globalisation of clinical laboratories and that occurs in four areas: a) Consumption of health services abroad; b) Movement of Health Personnel; c) Cross-Border delivery of trade; and d) Commercial presence. Each of these areas presents new challenges and opportunities for clinical laboratories, what will certainly shape the way we work today and in the future.
Clinical ; seconds ; trends ; SIZES ; technical requirement

The adverse health effects of elevated exposures to PM10 (particulate matter collected through a size selective inlet with an efficiency of 50% for particles with an aerodynamic diameter of 10 μm) in relation to morbidity and mortality, especially in susceptible individuals, are now well recognised. PM10 consists of a variable cocktail of components differing in chemical composition and size. Epidemiological and toxicological data suggest that transition metals and ultrafine particles are both able to drive the cellular and molecular changes that underlie PM10-induced inflammation and so worsen disease status. Toxicological evidence also suggest roles for the biological components of PM10 including volatile organic compounds (VOC’s), allergens and bacterial-derived endotoxin. Many of these components, in particular transition metals, ultrafine particles, endotoxin and VOC’s induce a cellular oxidative stress which initiates an intracellular signaling cascade involving the activation of phosphatase and kinase enzymes as well as transcription factors such as nuclear factor kappa B. Activation of these signaling mechanisms results in an increase in the expression of pro-inflammatory mediators, and hence enhanced inflammation. Given that many of the components of PM10 stimulate similar or even identical intracellular signaling pathways, it is conceivable that this will result in synergistic or additive interactions so that the biological response induced by PM10 exposure is a response to the composition rather than the mass alone. A small number of studies suggest that synergistic interactions occur between ultrafine particles and transition metals, between particles and allergens, and between particles and VOC’s. Elucidation of the consequences of interaction between the components of PM10 in relation to their biological activity implies huge consequences for the methods used to monitor and to legislate pollution exposure in the future, and may drive a move from mass based measurements to composition.
seconds ; Transition Elements ; SIZES ; Drug Interactions ; Cellular biology