Asymptomatic nodules of the upper lip: report of a canalicular adenoma with immunoprofile presentation

Canalicular adenoma is an uncommon benign tumour that generally arises in the minor salivary glands of individuals over 60 years old. This study illustrates a case of canalicular adenoma in a 70-year-old female, presenting as two distinct asymptomatic nodules in the upper lip. Immunohistochemistry analysis was performed. Clinical features, management, histology and immunoprofile from this case and from the literature are discussed.     

The challenge of participatory natural resource management with mobile herders at the scale of a Sub-Saharan African protected area

In Sub-Saharan Africa, the management of rangelands used by mobile populations, such as transhumant herders, must include large scale, sometimes cross-border, components. This mobility, common and significant in transhumant livestock production systems is, in most cases, not taken into account in conservation and natural resources management strategies around protected areas. Most conservation projects which include a development goal are designed to provide support to sedentary subsistence agricultural populations. Securing “pastoral lands” is seldom included as part of protected areas land management approaches. This paper focuses on the difficulty of integrating pastoral, agricultural and conservation issues into a regional land management plan. Based on a case study in Chad (Zakouma National Park), we pay particular attention to local mechanisms of land tenure negotiation, the mobile actors and the complex political landscape that this creates.     

Successful management of allergy to the insulin excipient metacresol in a child with type 1 diabetes: a case report

ABSTRACT: INTRODUCTION: Insulin allergy to human insulin preparations during the treatment of diabetes is suggested to occur at rates ranging from <1.0% to 2.4%. These reactions vary from mild localized reactions, which resolve with repeated exposure, to life-threatening anaphylaxis and death. The management of persistent insulin allergy in type 1 diabetes mellitus is particularly complicated because ongoing treatment with insulin is essential. CASE PRESENTATION: We present the case of a 12-year-old Caucasian girl with localized allergy to the insulin excipient metacresol, and the subsequent desensitization therapy using continuous subcutaneous insulin infusion with simultaneous intravenous insulin infusion. CONCLUSIONS: This is the first documented case of allergy to the metacresol component of insulin in the pediatric type 1 diabetes literature. We describe an approach to diagnosis and management of metacresol allergy in type 1 diabetes.     

Management of squamous cell carcinoma in a patient with dominant-type epidermolysis bullosa dystrophica: a surgical challenge

Epidermolysis bullosa dystrophica is a rare congenital skin disease inherited either as a recessive or dominant form, the latter form being less common and much less severe. Squamous cell carcinoma is a rare complication in the dominant form of the disease, only three such cases being reported before, making this case the fourth known case. Although the squamous cell carcinoma is well-differentiated by histopathology, it has a poor prognosis owing to its invasiveness, distant metastases, and multicentricity. Its management also poses a great challenge to the surgeon and personnel involved in patient care. A complete outline of the total management of such a case is described with some interesting observations not mentioned previously in the literature. All the previous three patients are deceased, and this is the only known surviving patient.     

潍坊市实施儿童预防接种信息化管理系统建设效果评价

目的了解潍坊市儿童预防接种个案信息化管理情况,为免疫规划管理提供科学依据。方法采用《金苗免疫助手系统》软件,建立儿童预防接种个案数据库,通过磁卡识别系统进行接种。结果截至2010年儿童接种个案信息常住与流动儿童分别录入794 015和117 192人,录入管理率分别为99.80%、96.11%;流动儿童建卡、证信息化电子网络管理前后相比具有统计学意义(χ2=4.52,0.01相似文献   

Biofeedback for the treatment of anal incontinence in a child with ureterosigmoidostomy

The case of a 7-year-old boy born with exstrophy of the bladder is presented. Biofeedback and behavioral therapy were employed in the treatment of anal incontinence, which occurred following ureterosigmoidostomy diversion. After 19 treatment and follow-up sessions over a period of 12 months, there was significant decrease in fecal/urinary incontinence. The patient was soiled 29% of waking hours over the first 4 weeks of treatment. This figure dropped to 9.7% over the last three sessions. Subjective satisfaction of parent, child, and teachers was high. These gains were maintained over a 12-month follow-up period. Given the design of the present study, it is not possible to determine whether the biofeedback per se had a specific treatment effect. The case demonstrates the usefulness of a broad-based behavior therapy in the management of fecal/urine soiling, which is a frequent, refractory complication of ureterosigmoidostomy.     

Biofeedback for the treatment of anal incontinence in a child with ureterosigmoidostomy

The case of a 7-year-old boy born with exstrophy of the bladder is presented. Biofeedback and behavioral therapy were employed in the treatment of anal incontinence, which occurred following ureterosigmoidostomy diversion. After 19 treatment and follow-up sessions over a period of 12 months, there was significant decrease in fecal/urinary incontinence. The patient was soiled 29% of waking hours over the first 4 weeks of treatment. This figure dropped to 9.7% over the last three sessions. Subjective satisfaction of parent, child, and teachers was high. These gains were maintained over a 12-month follow-up period. Given the design of the present study, it is not possible to determine whether the biofeedback per se had a specific treatment effect. The case demonstrates the usefulness of a broad-based behavior therapy in the management of fecal/urine soiling, which is a frequent, refractory complication of ureterosigmoidostomy.     

Cologastric fistula with a foreign body in a patient with Crohn's disease

Although the medical management of fistulizing Crohn's disease is improving, a subset of patients does not respond to maximal medical therapy and is referred for surgical consultation. We report a case of Crohn's colitis with an ingested foreign body resulting in a cologastric fistula. The patient underwent segmental colectomy and takedown of the cologastric fistula. At the time of laparotomy, the foreign body was found in the fistulous colonic segment. The presence of an ingested foreign body likely contributed to a rare fistula that was refractory to medical management.     

Efficient Use of Information in Adaptive Management with an Application to Managing Recreation near Golden Eagle Nesting Sites

It is generally the case that a significant degree of uncertainty exists concerning the behavior of ecological systems. Adaptive management has been developed to address such structural uncertainty, while recognizing that decisions must be made without full knowledge of how a system behaves. This paradigm attempts to use new information that develops during the course of management to learn how the system works. To date, however, adaptive management has used a very limited information set to characterize the learning that is possible. This paper uses an extension of the Partial Observable Markov Decision Process (POMDP) framework to expand the information set used to update belief in competing models. This feature can potentially increase the speed of learning through adaptive management, and lead to better management in the future. We apply this framework to a case study wherein interest lies in managing recreational restrictions around golden eagle (Aquila chrysaetos) nesting sites. The ultimate management objective is to maintain an abundant eagle population in Denali National Park while minimizing the regulatory burden on park visitors. In order to capture this objective, we developed a utility function that trades off expected breeding success with hiker access. Our work is relevant to the management of human activities in protected areas, but more generally demonstrates some of the benefits of POMDP in the context of adaptive management.     

Benign paratesticular fibrous pseudotumor with malignant clinical features

Paratesticular tumors are rare intrascrotal masses that grow mainly in structures containing connective tissue around the testis, epididymis, or spermatic cord. We report here on a case of a 55-year-old man with a mass in the hemiscrotum that was found to be a paratesticular fibrous pseudotumor in the orchiectomy specimen pathologic examination. From this case report and literature review, a diagnostic and therapeutic strategy is demonstrated for the management of this uncommon lesion.     

Toxoplasmosis in a patient with non-Hodgkin's lymphoma: the need for a good differential diagnosis

Toxoplasma gondii is an obligate intracellular parasite responsible for toxoplasmosis. Congenital and acquired forms of the disease have now been reported. In immunocompromised patients, the disease entity may resemble other diseases. Presented for discussion is an interesting case of acquired toxoplasmosis in an immunocompromised patient with several confounding factors necessitating a good differential diagnosis list. Also provided is a comprehensive review of toxoplasmosis diagnosis and management.     

Quality of Inpatient Pediatric Case Management for Four Leading Causes of Child Mortality at Six Government-Run Ugandan Hospitals

BackgroundA better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care.MethodsAll children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression.ResultsA total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea.ConclusionsAppropriate management of suspected anemia and diarrhea occurred infrequently. Pediatric quality improvement initiatives should target deficiencies in care unique to each health facility, and interventions should focus on the simultaneous management of multiple diagnoses.     

Resilience thinking: Interview with Brian Walker

Summary   This interview with Brian Walker, chair of the research-based Resilience Alliance, outlines the main concepts and propositions behind 'resilience thinking' and touches on the importance of this paradigm for individuals and organizations involved in managing complex social-ecological systems. It refers to the origins, work and publications of the Resilience Alliance, listing and elaborating the key case studies used to illustrate the Alliance's main proposition that complex social-ecological systems do not behave in a predictable linear fashion. Rather, research indicates it is normal for complex systems to go through cycles of increasing and decreasing resilience and to have potential to shift, (in a self-organising way) to potentially undesirable states or entirely new systems if certain component variables are severely impacted by management. Such shifts can be novel and 'surprising', and are often not beneficial or desirable for societies. This is particularly the case where small-scale solutions push the problem upwards in a system, causing loss of resilience at a global scale. Predicting thresholds is therefore important to managers and is a key research focus for members of the Resilience Alliance who are currently building an accessible database to support decision-making in global natural resource management.     

Replantation of an avulsive amputation of a foot after recovering the foot from the sea

A foot avulsion case, with the dismembered body part submerged in sea water for 1 hour, is presented. This report is unique in that it is the first to document the reattachment of a body part that had been submerged in sea water. It was not known how salt-water exposure would affect wound management. Differences in osmolarity and bacterial flora between the sea water and foot tissues have not caused any problems, and the patient has not suffered any vascular or infectious complications after replantation. Neurotization of the plantar surface by the tibial nerve, which was stripped off during amputation and replaced in its original traces, was the most critical part of convalescence. After management of such an interesting case, we conclude that exposure to sea water of the dismembered part should not be a contraindication for replantation surgery.     

Non-ketotic hyperosmolar coma with insulin resistance in a 12-year-old girl

Although the frequency of recognition of the syndrome of non-ketotic hyperosmolar coma is increasing in all age groups the mortality rate remains high. This paper reports the occurrence of this syndrome in a 12-year-old girl. The pathogenesis is discussed and a planned approach to the management of circulatory collapse, hypokalemia, hyperglycemia and hyperosmolarity over the initial 24 hours is proposed. The phenomenon of insulin resistance which was observed in this case is a rare complication of this syndrome. Awareness of the occurrence of this syndrome in all age groups, early recognition of its features and a planned approach to management are mandatory to reduce the very high mortality rate.     

Squamous cell carcinoma associated with amoebic cervicitis. Report of a case

A case of squamous cell carcinoma associated with amebiasis is presented. Protozoa identified as Entamoeba histolytica were found in a routine Papanicolaou smear and in the cervical biopsy of a young woman following the initial diagnosis of cervical cancer and the institution of a radiation therapy regimen. No amoebae were found in repeated stool specimens. The late detection and diagnosis of amebiasis precluded any possible changes in the management of the case. Initial follow-up for the carcinoma demonstrated that the patient was not responding well to therapy; her failure to return to the clinic precluded long-term follow-up and treatment for the amebiasis.     

Cartilaginous choristoma of the tongue

Choristomas are lesions composed of normal cells or tissues occurring in an abnormal location. Cartilaginous choristomas of the oral mucosa are rare and occur preferentially on the tongue and less often in sites such as the soft palate and gingiva. Oral lesions are generally covered by integral mucosa and can occur at any age. The present study describes a case of a 73-year-old female presenting with an asymptomatic cartilaginous choristoma on the ventral surface of the tongue which had developed over a period of 3 years. The clinical presentation and management of the case are discussed and the literature is reviewed. This is the 28th reported case of a cartilaginous choristoma of the tongue and the third with a ventral localisation.     

Managing the socialization of an adult male gorilla (Gorilla gorilla gorilla) with a history of social deprivation

Most non‐human primates exhibit aggression during changes in social group composition. In zoological parks, group membership changes are necessary for optimal population management, but can elicit problematic aggression. Furthermore, some primates with a long history of social deprivation are hyperaggressive when introduced to conspecifics. In this study of one male gorilla with a 30‐year history of social deprivation, we assessed the rate of aggression quantitatively during a four‐step socialization procedure. We hypothesized that 1) the frequency of agonistic/display behaviors would increase markedly at the beginning of each phase of the socialization, then decline to baseline levels over time in each phase and 2) the frequency of affiliative behaviors would not vary systematically within or between phases of socialization. Our results largely supported these predictions, and we found the four‐step socialization process effective in managing aggression in this case. In addition to documenting the successful socialization of a socially deprived adult male gorilla, we believe that the empirical process used in this case argues for scientific management of other introductions. Zoo Biol 20:347–358, 2001. © 2001 Wiley‐Liss, Inc.     

“Because Somebody Cared about Me. That's How It Changed Things”: Homeless,Chronically Ill Patients’ Perspectives on Case Management

Background

Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants’ perspectives on case management interventions.

Methods

This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program.

Results

Four recurrent themes emerged: (1) Participants described profound social isolation prior to case management program enrollment; (2) Participants perceived that caring personal relationships with case managers were key to the program; (3) Participants valued assistance with navigating medical and social systems; and (4) Participants perceived that their health improved through both the interpersonal and the practical aspects of case management.

Conclusions

Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.