Common Tenderness Research Articles

Tender Cutaneous Neoplasms: Case Reports of Patients With a Symptomatic Dermatofibroma and a New Acrostic for Painful Tumors of the Skin

The most common tender cutaneous neoplasm is a dermatofibroma. The characteristics of three women (35 to 42 years old) with painful dermatofibromas are described. One woman was receiving immunosuppressive therapy for the past decade following a liver transplant; the other women were healthy. The dermatofibroma was located onthe buttock, shoulder, and arm, respectively; tumor-related pain had been present for several months to at least a year. The dermal nodules ranged in diameter from 5 millimeters to 12 millimeters and were either flesh-colored to slightly red or brown or tan; one tumor was surrounded by a hyperpigmented patch. Microscopic examination showed the following dermatofibroma variants: classic (fibrocollagenous) in two women and histiocytic in one woman. All the women experienced resolution, without recurrence, of pain following the punch biopsy that only removed the majority (but not all) of the dermatofibroma. Tender cutaneous neoplasms include not only dermatofibromas and other fibrous lesions, but also adipose, bone, calcium, cartilage, eccrine, infiltrative, lymphoproliferative, muscle, neural, and vascular tumors. Acronyms and acrostics are mnemonic devices that have been used by clinicians to aid in recalling the diagnoses associated with painful skin tumors. When there were only 11 or less number of pain-related cutaneous conditions, shorter acronyms associated with either a woman's name, a country or an egg were used. A unique acrostic inspired by Charlotte's Web, a children's book by E. B. White, was created when the differential diagnosis of tender cutaneous neoplasms expanded to 25 tumors. The sequential discovery of additional tender skin lesions resulted in two subsequent minor revisions to the original, hog-related, mnemonic. Herein, a new acrostic -- that is not only able to incorporate the inspiration from Charlotte's Web, but also includes cutaneous lymphoma and a final category of "everything else" in order to maintain the future integrity of mnemonic -- for the painful tumors of the skin is proposed: HOG FLED PEN AND GETS CALM LIFE BACK (hidradenoma, osteoma cutis, glomus tumor, fibromyxoma [superficial acral], leiomyosarcoma [cutaneous], eccrine angiomatous hamartoma, Dercum's disease, piezogenic pedal papule, eccrine spiradenoma, neurilemmoma, angiolipoma, neuroma, dermatofibroma, granular cell tumor, endometriosis [cutaneous], thrombus [cutaneous organizing], scar, calcinosis cutis, angioendotheliomatosis [reactive], leiomyoma, metastases [cutaneous], lymphoma [cutaneous], intravenous lobular capillary hemangioma, foreign body [and foreign body reaction], everything else, blue rubber bled nevus, angioma [tufted], chondrodermatitis nodularis helicis, and keloid).

Influence of the new tender law on construction project bid prices and durations in Kuwait

The public construction industry is a complex industry that mandates many restrictions, consists of different prolonged phases, and involves various approvals, a great number of authorities, and party associations. The tender stage is crucial in any construction project; it sets the basis of the second party selection to a contract, which is essential for the success of the project. The State of Kuwait issued The New Tender Law (No. 49 of 2016) aligning with the rapid development of laws and regulations. The New Tender Law has introduced twenty modifications, which were included in a survey distributed to a number of participants with experience in the public construction industry in Kuwait. Ninety-three completed surveys were gathered and included in the research’s analysis. Box plot and weighted average, along with the standard deviation, were used to sort the twenty tender law modifications according to their influence on bid price and overall project duration. Encouragement of foreign investment, changing contractor classifications, lengthy award processes, and prequalification and the possibility of rebidding are common tender law modifications that have significant impacts on both attributes.

How Procurement Judges The Value of Medical Technologies: A Review of Healthcare Tenders.

Procurement's important role in healthcare decision making has encouraged criticism and calls for greater collaboration with health technology assessment (HTA), and necessitates detailed analysis of how procurement approaches the decision task. We reviewed tender documents that solicit medical technologies for patient care in Canada, focusing on request for proposal (RFP) tenders that assess quality and cost, supplemented by a census of all tender types. We extracted data to assess (i) use of group purchasing organizations (GPOs) as buyers, (ii) evaluation criteria and rubrics, and (iii) contract terms, as indicators of supplier type and market conditions. GPOs were dominant buyers for RFPs (54/97) and all tender types (120/226), and RFPs were the most common tender (92/226), with few price-only tenders (11/226). Evaluation criteria for quality were technical, including clinical or material specifications, as well as vendor experience and qualifications; "total cost" was frequently referenced (83/97), but inconsistently used. The most common (47/97) evaluative rubric was summed scores, or summed scores after excluding those below a mandatory minimum (22/97), with majority weight (64.1 percent, 62.9 percent) assigned to quality criteria. Where specified, expected contract lengths with successful suppliers were high (mean, 3.93 years; average renewal, 2.14 years), and most buyers (37/42) expected to award to a single supplier. Procurement's evaluative approach is distinctive. While aiming to go beyond price in the acquisition of most medical technologies, it adopts a narrow approach to assessing quality and costs, but also attends to factors little considered by HTA, suggesting opportunities for mutual lesson learning.

Clinical Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort: Incidence, Prevalence, Characteristics, and Outcome.

To evaluate the incidence, prevalence, characteristics, disease associations, risk factors, and outcome of clinical enthesitis in patients with psoriatic arthritis (PsA). The study included patients with PsA followed prospectively. Enthesitis was defined as the presence of at least 1 tender enthesis at 1 of the 18 entheseal sites of the Spondyloarthritis Research Consortium of Canada enthesitis index. Between 2008 and 2014, 281 of 803 patients had enthesitis, providing a prevalence of 35%. A total of 192 patients developed enthesitis during the course of followup, with an annual incidence of 0.9%. Most of the patients had 1 (48.4%) or 2 (32.2%) tender entheseal sites, and the mean ± SD number of sites per visit was 2.03 ± 1.6. The 3 most common sites were at the insertions of the Achilles tendon, plantar fascia on the calcaneus, and the lateral epicondyles (24.2%, 20.8%, and 17.2%, respectively). More active disease (higher actively inflamed joint count, tenosynovitis, and dactylitis), more pain, and less clinical damage were associated with enthesitis. Higher body mass index, more actively inflamed joints, and younger age were risk factors for developing this condition. Enthesitis resolved in most patients without changing treatment. Clinical enthesitis is common, with a period prevalence of 35% of PsA patients. It usually involves only 1 or 2 sites simultaneously. The most common tender sites are at the insertions of the Achilles tendon, plantar fascia, and the lateral epicondyles. More active disease and more pain are associated with enthesitis.

Characteristics and Etiologies of Chronic Scrotal Pain: A Common but Poorly Understood Condition.

Chronic scrotal pain (CSP) is a common and debilitating condition, but the underlying characteristics and etiology of CSP are poorly understood. The objective of this study is to identify the characteristic and etiologies of CSP. Men presenting for management of CSP completed a standardized questionnaire and underwent a complete physical examination. From Feb 2014 to Sep 2015, a total of 131 men (mean age 43) with CSP were studied. The CSP was of long duration (mean of 4.7 ± 5.95 years) and dramatically affected men's lives, with adverse effects on normal activities (71.%), ability to work (51.90%), and sexual functioning (61.8%). 50.4% felt depressed on most days, and 67.17% felt either unhappy or terrible with their present condition. Physical examination revealed that the epididymis was the most common tender area found in 70/131 men (53.43%), though a musculoskeletal source for the pain was found in 9.9%. Neuropathic changes were found in 30%. For close to half of the men (43.5%) we were unable to identify any potential cause for the CSP. This study characterizes the dramatic impact that CSP has on the lives of men, while providing an understanding of the common etiologies.

THE REALITY OF DIGITAL CURRENCY AS A FINANCIAL MEDIUM OF EXCHANGE

ABSTRACT This paper presents a discussion of the requirements for the long term acceptance of digital currency as a financial medium of exchange through the examination of fundamental criteria associated with common tender and the examination of selected digital currencies. According to the U.S. Treasury, digital currencies are subject to regulation if that digital currency has a substitutive purpose for facilitating exchanging goods and services (Financial Crimes Enforcement Network, 2013). Although governments can place stipulations on currencies, users of common tender, such as digital currencies, expect at least three basic privileges for a digital currency to evolve from conception to realization. First, a digital currency must be considered intangible personal property similar to trademarks, copyrights, and patents. Second, ownership disputes must be subject to a system such as a Judicial Proceeding or Binding Arbitration to resolve property conflicts. Finally, a digital currency must be subject to similar regulation as other financial instruments (e.g., legal tender, scrip, and credit cards) used in facilitating exchanges. Keywords Digital currency, common tender, currency regulation, virtual currency, medium of exchange.

DIGITAL COUNTERFEITING: STATES REGULATION OF FEDERAL, FOREIGN & DIGITAL FINANCIAL INSTRUMENTS USED AS CURRENCY

ABSTRACT The relatively recent appearance of Internet-based transactions necessitated the develop of digital forms of payment. These payments have evolved into various forms, including digital currency. This paper discusses the regulatory authority and/or lack of authority, of the sovereign States of the United States to regulate the counterfeiting of financial instruments used as currency, including digital currency. Federal and Foreign (non-U.S.) currencies are explicitly examined. Some digital currencies are not regulated or authorized specifically by a government. Can a currency without formal codification from a government be regulated by a State? As financial transactions have shifted historically from various governments’ legal tender to combinations of government and private issuances and from the hard currency of coins and paper to electronic transactions, many States’ counterfeiting statutes are unclear or fail to consider that technological changes can impact legal and common tender. The rise in transactions being facilitated in digital currencies and regulations protecting states from digital counterfeiting is examined and discussed. Keywords Financial instruments, fiscal policy, currency, monetary policy, digital currency, counterfeiting.

A Rarely Encountered Complication due to the Use of Warfarin: Spontaneous Intramural Hematoma in Jejunum: Two Case Reports

Spontaneous intramural small bowel hematoma due to the overuse of warfarin is a rarely encountered complication. In most patients, hematoma may be ameliorated with conservative modalities, and surgery is rarely needed. We presented two cases here. The first, a 81-year-old male patient, was admitted to our clinic with the complaint of abdominal pain and on the use of warfarin (5 mg/day) due to cerebrovascular event, congestive heart failure and atrial fibrillation. The physical examination revealed tenderness on abdominal left upper and lower quadrants. Prothrombin time, activated partial thromboplastin time and international normalized ratio were too long to measure clotting. On abdominal computerized tomography of the patient presenting with intestinal wall thickness on ultrasonography, wall thickness suggesting intramural hematoma was seen. Warfarin was discontinued, and fresh frozen plasma, erythrocyte suspension and intravenous fluids were given. During the follow-up, prothrombin time and international normalized ratio decreased to 14.6 seconds and 1.3, respectively, and hematoma was found to reduced on abdominal US. The second case, a 76-year-old woman patient and on the use of warfarin (5 mg/day), was admitted to the clinic with the complaints of abdominal pain, nausea and vomiting. She indicated common tenderness on abdominal examination, and activated partial thromboplastin time, prothrombin time and international normalized ratio were measured as 51.4 seconds, 43.9 seconds, and 3.8, respectively. Direct abdominal graphy showed no pathological finding. Abdominal ultrasonography and computerized tomography revealed wall thickness consistent with intramural hematoma on jejunum. Warfarin was discontunued, and fresh frozen plasma and intravenous fluids were administered. Activated partial thromboplastin time, prothrombin time and international normalized ratio were respectively decresed to 33.7 seconds, 20.1 seconds, and 1.7. Spontaneous intramural small bowel hematoma is a serious complication, so early diagnosis and prompt medical treatment are important. Many patients may be treated with conservative modalities successfully. J Med Cases. 2013;4(8):560-563 doi: http://dx.doi.org/10.4021/jmc1377w

A Rarely Encountered Complication due to the Use of Warfarin: Spontaneous Intramural Hematoma in Jejunum: Two Case Reports

Spontaneous intramural small bowel hematoma due to the overuse of warfarin is a rarely encountered complication. In most patients, hematoma may be ameliorated with conservative modalities, and surgery is rarely needed. We presented two cases here. The first, a 81-year-old male patient, was admitted to our clinic with the complaint of abdominal pain and on the use of warfarin (5 mg/day) due to cerebrovascular event, congestive heart failure and atrial fibrillation. The physical examination revealed tenderness on abdominal left upper and lower quadrants. Prothrombin time, activated partial thromboplastin time and international normalized ratio were too long to measure clotting. On abdominal computerized tomography of the patient presenting with intestinal wall thickness on ultrasonography, wall thickness suggesting intramural hematoma was seen. Warfarin was discontinued, and fresh frozen plasma, erythrocyte suspension and intravenous fluids were given. During the follow-up, prothrombin time and international normalized ratio decreased to 14.6 seconds and 1.3, respectively, and hematoma was found to reduced on abdominal US. The second case, a 76-year-old woman patient and on the use of warfarin (5 mg/day), was admitted to the clinic with the complaints of abdominal pain, nausea and vomiting. She indicated common tenderness on abdominal examination, and activated partial thromboplastin time, prothrombin time and international normalized ratio were measured as 51.4 seconds, 43.9 seconds, and 3.8, respectively. Direct abdominal graphy showed no pathological finding. Abdominal ultrasonography and computerized tomography revealed wall thickness consistent with intramural hematoma on jejunum. Warfarin was discontunued, and fresh frozen plasma and intravenous fluids were administered. Activated partial thromboplastin time, prothrombin time and international normalized ratio were respectively decresed to 33.7 seconds, 20.1 seconds, and 1.7. Spontaneous intramural small bowel hematoma is a serious complication, so early diagnosis and prompt medical treatment are important. Many patients may be treated with conservative modalities successfully. J Med Cases. 2013;4(8):560-563 doi: http://dx.doi.org/10.4021/jmc1377w

Short monetary systems: take a risk, create money

PurposeThe purpose of this editorial is to examine fiat currencies and common tenders (trade‐based money) from a risk perspective. The editorial encourages risk managers to consider the distributive benefits of a multiplicity of currencies and urges them to examine common tenders both old, such as the Swiss WIR, and novel, such as capacity exchange monies, as risk management tools.Design/methodology/approachThe editorial is based on research conducted for the City of London Corporation in 2011 into capacity, trade and credit which examined new architectures for commerce and money.FindingsThe editorial links Freiwirtschaft movement ideas with some characteristics of common tenders. Further, it considers whether some simple regulatory approaches might make such common tenders more useful.Originality/valueOf note, the author suggests that a modern alternative to government regulation might be an audited ISO accreditation standard for “good currency” or “good common tender”.

Características de pacientes com síndrome da fibromialgia atendidos em hospital de Salvador-BA, Brasil

OBJECTIVE: to describe the demographic, socioeconomic and clinical characteristics of patients with Fibromyialgia Syndrome (FS) assisted at the Hospital Santo Antonio in Salvador, BA, Brazil. METHODS: a hundred and twenty patients with FS were prospectively evaluated by two rheumatologists in relation to the clinical-epidemic data and clinical manifestations. RESULTS: all the patients were female, with average age of 29.8 years. Diffuse pain was found in all patients and fatigue was found in 94.2% (n = 113). Anxiety was referred by 105 patients (87.5%) and depression by 47 (39.2%) of them. The most common tender point found was the right subocciput, reported by 40% (n = 48) of the patients and the less found was the right gluteal, in 26.7% (n = 26). The mean of the total number of tender points was 13.6 (limits from 11 to 18), being the average and the median 14. The patients' group that had the number of tender points superior or equal to the median presented, significantly, lower family income (p < 0.01), larger smoking habit (p < 0.01) and sleeping disturbances (p < 0.05) when compared to the others. CONCLUSIONS: the appraised patients presented several characteristics in common with patients of previous studies, but they differed in relation to the frequencies of total and specific tender points. We found a significant association of low family income, sleeping disturbances and smoking habit with a larger amount of tender points.