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Unknown | 1992-06-06 | 291.0 KB |
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Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
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|00000400| 03 00 ba 0a 00 00 37 32 | 00 00 00 01 79 4f 03 00 |......72|....yO..|
|00000410| 28 09 00 00 37 33 00 00 | 00 01 a1 58 03 00 6d 0b |(...73..|...X..m.|
|00000420| 00 00 37 34 00 00 00 01 | 0e 64 03 00 9b 0a 00 00 |..74....|.d......|
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|00000460| a3 90 03 00 f4 09 00 00 | 37 39 00 00 00 01 97 9a |........|79......|
|00000470| 03 00 8c 0b 00 00 38 30 | 00 00 00 01 23 a6 03 00 |......80|....#...|
|00000480| f9 09 00 00 38 31 00 00 | 00 01 1c b0 03 00 6a 0c |....81..|......j.|
|00000490| 00 00 38 32 00 00 00 01 | 86 bc 03 00 21 0b 00 00 |..82....|....!...|
|000004a0| 38 33 00 00 00 01 a7 c7 | 03 00 14 0c 00 00 38 34 |83......|......84|
|000004b0| 00 00 00 01 bb d3 03 00 | b7 0c 00 00 38 35 00 00 |........|....85..|
|000004c0| 00 01 72 e0 03 00 4a 08 | 00 00 38 36 00 00 00 01 |..r...J.|..86....|
|000004d0| bc e8 03 00 55 0c 00 00 | 38 37 00 00 00 01 11 f5 |....U...|87......|
|000004e0| 03 00 43 0a 00 00 38 38 | 00 00 00 01 54 ff 03 00 |..C...88|....T...|
|000004f0| 8b 0b 00 00 38 39 00 00 | 00 01 df 0a 04 00 e7 0a |....89..|........|
|00000500| 00 00 39 30 00 00 00 01 | c6 15 04 00 f4 0b 00 00 |..90....|........|
|00000510| 39 31 00 00 00 01 ba 21 | 04 00 e3 0d 00 00 39 32 |91.....!|......92|
|00000520| 00 00 00 01 9d 2f 04 00 | 10 08 00 00 39 33 00 00 |...../..|....93..|
|00000530| 00 01 ad 37 04 00 17 0b | 00 00 39 34 00 00 00 01 |...7....|..94....|
|00000540| c4 42 04 00 d4 0b 00 00 | 39 35 00 00 00 01 98 4e |.B......|95.....N|
|00000550| 04 00 1a 0a 00 00 39 36 | 00 00 00 01 b2 58 04 00 |......96|.....X..|
|00000560| f6 09 00 00 39 37 00 00 | 00 01 a8 62 04 00 52 0e |....97..|...b..R.|
|00000570| 00 00 39 38 00 00 00 01 | fa 70 04 00 21 0b 00 00 |..98....|.p..!...|
|00000580| 39 39 00 00 00 01 1b 7c | 04 00 ba 0f 00 00 00 00 |99.....||........|
|00000590| 00 00 00 00 d5 8b 04 00 | 00 00 00 00 24 55 6e 69 |........|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 39 33 30 30 7d |que_ID{Y|RB09300}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 43 6c 69 6e 69 63 61 |..$Title|{Clinica|
|000005c0| 6c 20 50 61 72 61 6d 65 | 74 65 72 73 20 61 6e 64 |l Parame|ters and|
|000005d0| 20 54 72 61 6e 73 63 75 | 74 61 6e 65 6f 75 73 20 | Transcu|taneous |
|000005e0| 4f 78 79 67 65 6e 20 4d | 65 61 73 75 72 65 6d 65 |Oxygen M|easureme|
|000005f0| 6e 74 73 20 66 6f 72 20 | 74 68 65 20 50 72 6f 67 |nts for |the Prog|
|00000600| 6e 6f 73 69 73 20 6f 66 | 20 56 65 6e 6f 75 73 20 |nosis of| Venous |
|00000610| 55 6c 63 65 72 73 7d 0d | 0a 24 41 75 74 68 6f 72 |Ulcers}.|.$Author|
|00000620| 7b 4e 65 6d 65 74 68 2c | 20 41 4a 0d 0a 45 61 67 |{Nemeth,| AJ..Eag|
|00000630| 6c 73 74 65 69 6e 2c 20 | 57 48 0d 0a 46 61 6c 61 |lstein, |WH..Fala|
|00000640| 6e 67 61 2c 20 56 7d 0d | 0a 24 41 66 66 69 6c 69 |nga, V}.|.$Affili|
|00000650| 61 74 69 6f 6e 7b 55 6e | 69 76 20 6f 66 20 50 69 |ation{Un|iv of Pi|
|00000660| 74 74 73 62 75 72 67 68 | 7d 0d 0a 24 4a 6f 75 72 |ttsburgh|}..$Jour|
|00000670| 6e 61 6c 7b 4a 20 41 6d | 20 41 63 61 64 20 44 65 |nal{J Am| Acad De|
|00000680| 72 6d 61 74 6f 6c 7d 0d | 0a 24 56 6f 6c 75 6d 65 |rmatol}.|.$Volume|
|00000690| 7b 32 30 7d 0d 0a 24 50 | 61 67 65 7b 31 38 36 2d |{20}..$P|age{186-|
|000006a0| 31 39 30 7d 0d 0a 24 44 | 61 74 65 7b 46 65 62 72 |190}..$D|ate{Febr|
|000006b0| 75 61 72 79 20 31 39 38 | 39 7d 0d 0a 24 59 42 56 |uary 198|9}..$YBV|
|000006c0| 6f 6c 7b 31 39 39 30 20 | 59 65 61 72 20 42 6f 6f |ol{1990 |Year Boo|
|000006d0| 6b 20 6f 66 20 44 65 72 | 6d 61 74 6f 6c 6f 67 79 |k of Der|matology|
|000006e0| 7d 0d 0a 24 43 68 61 70 | 74 65 72 7b 31 39 2d 32 |}..$Chap|ter{19-2|
|000006f0| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|00000700| 2e 20 53 6f 62 65 72 20 | 61 6e 64 20 46 69 74 7a |. Sober |and Fitz|
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|00000720| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|00000730| 7b 4a 2e 43 2e 20 41 6c | 70 65 72 2c 20 4d 2e 44 |{J.C. Al|per, M.D|
|00000740| 2e 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |.}....Co|pyright |
|00000750| 28 63 29 20 59 65 61 72 | 62 6f 6f 6b 20 4d 65 64 |(c) Year|book Med|
|00000760| 69 63 61 6c 20 50 75 62 | 6c 69 73 68 65 72 73 2c |ical Pub|lishers,|
|00000770| 20 49 6e 63 2e 2c 20 31 | 39 39 30 0d 0a 0d 0a 31 | Inc., 1|990....1|
|00000780| 39 39 30 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |990 Year| Book of|
|00000790| 20 44 65 72 6d 61 74 6f | 6c 6f 67 79 20 28 52 29 | Dermato|logy (R)|
|000007a0| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 31 39 2d 2d |....Chap|ter 19--|
|000007b0| 56 61 73 63 75 6c 61 72 | 20 44 69 73 6f 72 64 65 |Vascular| Disorde|
|000007c0| 72 73 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |rs....--|--------|
|000007d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000800| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000810| 2d 2d 2d 2d 0d 0a 43 6c | 69 6e 69 63 61 6c 20 50 |----..Cl|inical P|
|00000820| 61 72 61 6d 65 74 65 72 | 73 20 61 6e 64 20 54 72 |arameter|s and Tr|
|00000830| 61 6e 73 63 75 74 61 6e | 65 6f 75 73 20 4f 78 79 |anscutan|eous Oxy|
|00000840| 67 65 6e 20 4d 65 61 73 | 75 72 65 6d 65 6e 74 73 |gen Meas|urements|
|00000850| 20 66 6f 72 20 74 68 65 | 20 50 72 6f 67 6e 6f 73 | for the| Prognos|
|00000860| 69 73 0d 0a 6f 66 20 56 | 65 6e 6f 75 73 20 55 6c |is..of V|enous Ul|
|00000870| 63 65 72 73 0d 0a 0d 0a | 4e 65 6d 65 74 68 20 41 |cers....|Nemeth A|
|00000880| 4a 3b 20 45 61 67 6c 73 | 74 65 69 6e 20 57 48 3b |J; Eagls|tein WH;|
|00000890| 20 46 61 6c 61 6e 67 61 | 20 56 0d 0a 28 55 6e 69 | Falanga| V..(Uni|
|000008a0| 76 20 6f 66 20 50 69 74 | 74 73 62 75 72 67 68 29 |v of Pit|tsburgh)|
|000008b0| 0d 0a 4a 20 41 6d 20 41 | 63 61 64 20 44 65 72 6d |..J Am A|cad Derm|
|000008c0| 61 74 6f 6c 20 32 30 3a | 31 38 36 2d 31 39 30 2c |atol 20:|186-190,|
|000008d0| 20 46 65 62 72 75 61 72 | 79 20 31 39 38 39 0d 0a | Februar|y 1989..|
|000008e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00000930| 0d 0a 41 62 73 74 72 61 | 63 74 0d 0a 0d 0a 20 20 |..Abstra|ct.... |
|00000940| 20 20 20 54 72 61 6e 73 | 63 75 74 61 6e 65 6f 75 | Trans|cutaneou|
|00000950| 73 20 6f 78 79 67 65 6e | 20 70 72 65 73 73 75 72 |s oxygen| pressur|
|00000960| 65 20 28 54 63 50 4f 32 | 29 20 6d 6f 6e 69 74 6f |e (TcPO2|) monito|
|00000970| 72 69 6e 67 20 69 73 20 | 61 20 73 69 6d 70 6c 65 |ring is |a simple|
|00000980| 2c 20 72 61 70 69 64 2c | 0d 0a 6e 6f 6e 69 6e 76 |, rapid,|..noninv|
|00000990| 61 73 69 76 65 20 74 65 | 63 68 6e 69 71 75 65 20 |asive te|chnique |
|000009a0| 66 6f 72 20 64 65 74 65 | 72 6d 69 6e 69 6e 67 20 |for dete|rmining |
|000009b0| 6c 6f 63 61 6c 20 74 69 | 73 73 75 65 20 6f 78 79 |local ti|ssue oxy|
|000009c0| 67 65 6e 20 64 65 6c 69 | 76 65 72 79 20 74 68 72 |gen deli|very thr|
|000009d0| 6f 75 67 68 20 74 68 65 | 0d 0a 73 6b 69 6e 2e 20 |ough the|..skin. |
|000009e0| 20 57 68 65 74 68 65 72 | 20 74 68 65 20 6d 65 61 | Whether| the mea|
|000009f0| 73 75 72 65 6d 65 6e 74 | 20 6f 66 20 54 63 50 4f |surement| of TcPO|
|00000a00| 32 20 6c 65 76 65 6c 73 | 20 61 74 20 74 68 65 20 |2 levels| at the |
|00000a10| 75 6c 63 65 72 20 73 69 | 74 65 20 69 6e 20 70 61 |ulcer si|te in pa|
|00000a20| 74 69 65 6e 74 73 0d 0a | 77 69 74 68 20 76 65 6e |tients..|with ven|
|00000a30| 6f 75 73 20 73 6b 69 6e | 20 75 6c 63 65 72 73 20 |ous skin| ulcers |
|00000a40| 77 6f 75 6c 64 20 62 65 | 20 75 73 65 66 75 6c 20 |would be| useful |
|00000a50| 61 73 20 61 20 70 72 6f | 67 6e 6f 73 74 69 63 20 |as a pro|gnostic |
|00000a60| 74 6f 6f 6c 20 77 61 73 | 20 65 76 61 6c 75 61 74 |tool was| evaluat|
|00000a70| 65 64 20 69 6e 0d 0a 34 | 20 6d 65 6e 20 61 6e 64 |ed in..4| men and|
|00000a80| 20 31 30 20 77 6f 6d 65 | 6e 20 77 69 74 68 20 76 | 10 wome|n with v|
|00000a90| 65 6e 6f 75 73 20 75 6c | 63 65 72 73 20 69 6e 20 |enous ul|cers in |
|00000aa0| 31 34 20 6c 69 6d 62 73 | 20 77 68 6f 20 77 65 72 |14 limbs| who wer|
|00000ab0| 65 20 73 74 75 64 69 65 | 64 0d 0a 70 72 6f 73 70 |e studie|d..prosp|
|00000ac0| 65 63 74 69 76 65 6c 79 | 2e 20 20 54 68 65 20 6d |ectively|. The m|
|00000ad0| 65 61 6e 20 61 67 65 20 | 77 61 73 20 36 39 2e 36 |ean age |was 69.6|
|00000ae0| 20 79 65 61 72 73 2c 20 | 61 6e 64 20 75 6c 63 65 | years, |and ulce|
|00000af0| 72 73 20 68 61 64 20 62 | 65 65 6e 20 70 72 65 73 |rs had b|een pres|
|00000b00| 65 6e 74 20 66 6f 72 20 | 61 0d 0a 6d 65 61 6e 20 |ent for |a..mean |
|00000b10| 64 75 72 61 74 69 6f 6e | 20 6f 66 20 31 35 2e 36 |duration| of 15.6|
|00000b20| 20 6d 6f 6e 74 68 73 20 | 62 65 66 6f 72 65 20 72 | months |before r|
|00000b30| 65 66 65 72 72 61 6c 2e | 20 20 41 6c 6c 20 31 34 |eferral.| All 14|
|00000b40| 20 70 61 74 69 65 6e 74 | 73 20 75 6e 64 65 72 77 | patient|s underw|
|00000b50| 65 6e 74 0d 0a 65 78 74 | 65 6e 73 69 76 65 20 65 |ent..ext|ensive e|
|00000b60| 76 61 6c 75 61 74 69 6f | 6e 2c 20 77 68 69 63 68 |valuatio|n, which|
|00000b70| 20 69 6e 63 6c 75 64 65 | 64 20 54 63 50 4f 32 20 | include|d TcPO2 |
|00000b80| 73 74 75 64 69 65 73 2e | 20 20 54 68 65 20 6d 65 |studies.| The me|
|00000b90| 61 6e 20 66 6f 6c 6c 6f | 77 2d 75 70 20 70 65 72 |an follo|w-up per|
|00000ba0| 69 6f 64 0d 0a 77 61 73 | 20 31 30 2e 35 20 6d 6f |iod..was| 10.5 mo|
|00000bb0| 6e 74 68 73 2e 0d 0a 20 | 20 20 20 20 44 75 72 69 |nths... | Duri|
|00000bc0| 6e 67 20 74 68 65 20 66 | 6f 6c 6c 6f 77 2d 75 70 |ng the f|ollow-up|
|00000bd0| 20 70 65 72 69 6f 64 20 | 74 68 65 20 75 6c 63 65 | period |the ulce|
|00000be0| 72 73 20 6f 66 20 34 20 | 70 61 74 69 65 6e 74 73 |rs of 4 |patients|
|00000bf0| 20 28 32 39 25 29 20 68 | 65 61 6c 65 64 20 77 69 | (29%) h|ealed wi|
|00000c00| 74 68 0d 0a 63 6f 6e 73 | 65 72 76 61 74 69 76 65 |th..cons|ervative|
|00000c10| 20 74 72 65 61 74 6d 65 | 6e 74 20 61 66 74 65 72 | treatme|nt after|
|00000c20| 20 61 20 6d 65 61 6e 20 | 68 65 61 6c 69 6e 67 20 | a mean |healing |
|00000c30| 74 69 6d 65 20 6f 66 20 | 34 2e 38 20 6d 6f 6e 74 |time of |4.8 mont|
|00000c40| 68 73 2e 20 20 54 72 65 | 61 74 6d 65 6e 74 0d 0a |hs. Tre|atment..|
|00000c50| 63 6f 6e 73 69 73 74 65 | 64 20 6f 66 20 74 6f 70 |consiste|d of top|
|00000c60| 69 63 61 6c 20 61 6e 64 | 20 73 79 73 74 65 6d 69 |ical and| systemi|
|00000c70| 63 20 61 6e 74 69 62 69 | 6f 74 69 63 73 20 61 6e |c antibi|otics an|
|00000c80| 64 20 63 6f 6e 76 65 6e | 74 69 6f 6e 61 6c 20 61 |d conven|tional a|
|00000c90| 6e 64 20 6f 63 63 6c 75 | 73 69 76 65 0d 0a 64 72 |nd occlu|sive..dr|
|00000ca0| 65 73 73 69 6e 67 73 2e | 20 20 4e 6f 6e 65 20 6f |essings.| None o|
|00000cb0| 66 20 74 68 65 20 6f 74 | 68 65 72 20 31 30 20 70 |f the ot|her 10 p|
|00000cc0| 61 74 69 65 6e 74 73 20 | 68 61 64 20 75 6c 63 65 |atients |had ulce|
|00000cd0| 72 20 68 65 61 6c 69 6e | 67 2e 20 20 4f 6e 65 20 |r healin|g. One |
|00000ce0| 75 6c 63 65 72 20 74 68 | 61 74 0d 0a 68 61 64 20 |ulcer th|at..had |
|00000cf0| 62 65 65 6e 20 68 65 61 | 6c 65 64 20 66 6f 72 20 |been hea|led for |
|00000d00| 35 20 6d 6f 6e 74 68 73 | 20 6c 61 74 65 72 20 72 |5 months| later r|
|00000d10| 65 63 75 72 72 65 64 2e | 20 20 4f 6e 6c 79 20 31 |ecurred.| Only 1|
|00000d20| 20 6f 66 20 74 68 65 20 | 37 20 70 61 74 69 65 6e | of the |7 patien|
|00000d30| 74 73 20 77 68 6f 20 68 | 61 64 0d 0a 6d 6f 72 65 |ts who h|ad..more|
|00000d40| 20 74 68 61 6e 20 31 20 | 75 6c 63 65 72 20 68 61 | than 1 |ulcer ha|
|00000d50| 64 20 61 6e 20 75 6c 63 | 65 72 20 74 68 61 74 20 |d an ulc|er that |
|00000d60| 68 65 61 6c 65 64 2e 0d | 0a 20 20 20 20 20 49 6e |healed..|. In|
|00000d70| 20 61 6c 6c 20 70 61 74 | 69 65 6e 74 73 20 74 68 | all pat|ients th|
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|00001df0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|00001e20| 2d 2d 2d 2d 2d 0d 0a 54 | 72 65 61 74 6d 65 6e 74 |-----..T|reatment|
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|00001ec0| 64 20 44 65 72 6d 61 74 | 6f 6c 20 32 31 3a 31 39 |d Dermat|ol 21:19|
|00001ed0| 31 2d 31 39 39 2c 20 41 | 75 67 75 73 74 20 31 39 |1-199, A|ugust 19|
|00001ee0| 38 39 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |89..----|--------|
|00001ef0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f30| 2d 2d 0d 0a 0d 0a 41 62 | 73 74 72 61 63 74 0d 0a |--....Ab|stract..|
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|00001fb0| 42 65 63 61 75 73 65 20 | 6b 65 72 61 74 69 6e 6f |Because |keratino|
|00001fc0| 63 79 74 65 73 20 66 72 | 6f 6d 20 6e 65 6f 6e 61 |cytes fr|om neona|
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|00002570| 20 41 73 20 74 68 65 20 | 61 75 74 68 6f 72 73 20 | As the |authors |
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|00003670| 74 20 6f 66 20 53 6b 69 | 6e 20 55 6c 63 65 72 73 |t of Ski|n Ulcers|
|00003680| 3a 20 20 41 20 44 6f 75 | 62 6c 65 2d 42 6c 69 6e |: A Dou|ble-Blin|
|00003690| 64 20 53 74 75 64 79 7d | 0d 0a 24 41 75 74 68 6f |d Study}|..$Autho|
|000036a0| 72 7b 4a 61 6e 73 73 65 | 6e 2c 20 50 41 4a 0d 0a |r{Jansse|n, PAJ..|
|000036b0| 4a 61 6e 73 73 65 6e 2c | 20 48 0d 0a 43 61 75 77 |Janssen,| H..Cauw|
|000036c0| 65 6e 62 65 72 67 68 2c | 20 47 0d 0a 44 65 20 44 |enbergh,| G..De D|
|000036d0| 6f 6e 63 6b 65 72 2c 20 | 50 0d 0a 44 65 20 42 65 |oncker, |P..De Be|
|000036e0| 75 6c 65 2c 20 4b 0d 0a | 4c 65 77 69 2c 20 50 0d |ule, K..|Lewi, P.|
|000036f0| 0a 54 79 74 67 61 74 2c | 20 48 46 0d 0a 4c 61 70 |.Tytgat,| HF..Lap|
|00003700| 69 65 72 65 2c 20 43 4d | 7d 0d 0a 24 41 66 66 69 |iere, CM|}..$Affi|
|00003710| 6c 69 61 74 69 6f 6e 7b | 4a 61 6e 73 73 65 6e 20 |liation{|Janssen |
|00003720| 52 65 73 65 61 72 63 68 | 20 46 6f 75 6e 64 2c 20 |Research| Found, |
|00003730| 42 65 65 72 73 65 2c 20 | 42 65 6c 67 69 75 6d 3b |Beerse, |Belgium;|
|00003740| 20 4d 53 20 43 6c 69 6e | 69 63 2c 20 4d 65 6c 73 | MS Clin|ic, Mels|
|00003750| 62 72 6f 65 6b 3b 20 55 | 6e 69 76 20 6f 66 20 4c |broek; U|niv of L|
|00003760| 69 65 67 65 2c 20 42 65 | 6c 67 69 75 6d 7d 0d 0a |iege, Be|lgium}..|
|00003770| 24 4a 6f 75 72 6e 61 6c | 7b 4a 20 41 6d 20 41 63 |$Journal|{J Am Ac|
|00003780| 61 64 20 44 65 72 6d 61 | 74 6f 6c 7d 0d 0a 24 56 |ad Derma|tol}..$V|
|00003790| 6f 6c 75 6d 65 7b 32 31 | 7d 0d 0a 24 50 61 67 65 |olume{21|}..$Page|
|000037a0| 7b 38 35 2d 39 30 7d 0d | 0a 24 44 61 74 65 7b 4a |{85-90}.|.$Date{J|
|000037b0| 75 6c 79 20 31 39 38 39 | 7d 0d 0a 24 59 42 56 6f |uly 1989|}..$YBVo|
|000037c0| 6c 7b 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |l{1990 Y|ear Book|
|000037d0| 20 6f 66 20 44 65 72 6d | 61 74 6f 6c 6f 67 79 7d | of Derm|atology}|
|000037e0| 0d 0a 24 43 68 61 70 74 | 65 72 7b 31 39 2d 36 7d |..$Chapt|er{19-6}|
|000037f0| 0d 0a 24 59 42 45 64 69 | 74 6f 72 7b 44 72 73 2e |..$YBEdi|tor{Drs.|
|00003800| 20 53 6f 62 65 72 20 61 | 6e 64 20 46 69 74 7a 70 | Sober a|nd Fitzp|
|00003810| 61 74 72 69 63 6b 7d 0d | 0a 24 54 61 62 6c 65 7b |atrick}.|.$Table{|
|00003820| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|00003830| 4a 2e 43 2e 20 41 6c 70 | 65 72 2c 20 4d 2e 44 2e |J.C. Alp|er, M.D.|
|00003840| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00003850| 63 29 20 59 65 61 72 62 | 6f 6f 6b 20 4d 65 64 69 |c) Yearb|ook Medi|
|00003860| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00003870| 49 6e 63 2e 2c 20 31 39 | 39 30 0d 0a 0d 0a 31 39 |Inc., 19|90....19|
|00003880| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|00003890| 44 65 72 6d 61 74 6f 6c | 6f 67 79 20 28 52 29 0d |Dermatol|ogy (R).|
|000038a0| 0a 0d 0a 43 68 61 70 74 | 65 72 20 31 39 2d 2d 56 |...Chapt|er 19--V|
|000038b0| 61 73 63 75 6c 61 72 20 | 44 69 73 6f 72 64 65 72 |ascular |Disorder|
|000038c0| 73 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |s....---|--------|
|000038d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003910| 2d 2d 2d 0d 0a 55 73 65 | 20 6f 66 20 54 6f 70 69 |---..Use| of Topi|
|00003920| 63 61 6c 20 4b 65 74 61 | 6e 73 65 72 69 6e 20 69 |cal Keta|nserin i|
|00003930| 6e 20 74 68 65 20 54 72 | 65 61 74 6d 65 6e 74 20 |n the Tr|eatment |
|00003940| 6f 66 20 53 6b 69 6e 20 | 55 6c 63 65 72 73 3a 20 |of Skin |Ulcers: |
|00003950| 20 41 20 44 6f 75 62 6c | 65 2d 42 6c 69 6e 64 0d | A Doubl|e-Blind.|
|00003960| 0a 53 74 75 64 79 0d 0a | 0d 0a 4a 61 6e 73 73 65 |.Study..|..Jansse|
|00003970| 6e 20 50 41 4a 3b 20 4a | 61 6e 73 73 65 6e 20 48 |n PAJ; J|anssen H|
|00003980| 3b 20 43 61 75 77 65 6e | 62 65 72 67 68 20 47 3b |; Cauwen|bergh G;|
|00003990| 20 44 65 20 44 6f 6e 63 | 6b 65 72 20 50 3b 20 44 | De Donc|ker P; D|
|000039a0| 65 20 42 65 75 6c 65 20 | 4b 3b 20 4c 65 77 69 20 |e Beule |K; Lewi |
|000039b0| 50 3b 0d 0a 54 79 74 67 | 61 74 20 48 46 3b 20 4c |P;..Tytg|at HF; L|
|000039c0| 61 70 69 65 72 65 20 43 | 4d 0d 0a 28 4a 61 6e 73 |apiere C|M..(Jans|
|000039d0| 73 65 6e 20 52 65 73 65 | 61 72 63 68 20 46 6f 75 |sen Rese|arch Fou|
|000039e0| 6e 64 2c 20 42 65 65 72 | 73 65 2c 20 42 65 6c 67 |nd, Beer|se, Belg|
|000039f0| 69 75 6d 3b 20 4d 53 20 | 43 6c 69 6e 69 63 2c 20 |ium; MS |Clinic, |
|00003a00| 4d 65 6c 73 62 72 6f 65 | 6b 3b 20 55 6e 69 76 20 |Melsbroe|k; Univ |
|00003a10| 6f 66 20 4c 69 65 67 65 | 2c 0d 0a 42 65 6c 67 69 |of Liege|,..Belgi|
|00003a20| 75 6d 29 0d 0a 4a 20 41 | 6d 20 41 63 61 64 20 44 |um)..J A|m Acad D|
|00003a30| 65 72 6d 61 74 6f 6c 20 | 32 31 3a 38 35 2d 39 30 |ermatol |21:85-90|
|00003a40| 2c 20 4a 75 6c 79 20 31 | 39 38 39 0d 0a 2d 2d 2d |, July 1|989..---|
|00003a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00003aa0| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|00003ab0| 4b 65 74 61 6e 73 65 72 | 69 6e 20 69 73 20 61 20 |Ketanser|in is a |
|00003ac0| 73 65 72 6f 74 6f 6e 65 | 72 67 69 63 20 61 6e 74 |serotone|rgic ant|
|00003ad0| 61 67 6f 6e 69 73 74 20 | 74 68 61 74 20 63 6f 6d |agonist |that com|
|00003ae0| 70 65 74 69 74 69 76 65 | 6c 79 20 61 6e 64 0d 0a |petitive|ly and..|
|00003af0| 73 65 6c 65 63 74 69 76 | 65 6c 79 20 62 6c 6f 63 |selectiv|ely bloc|
|00003b00| 6b 73 20 53 32 2d 73 65 | 72 6f 74 6f 6e 65 72 67 |ks S2-se|rotonerg|
|00003b10| 69 63 20 72 65 63 65 70 | 74 6f 72 73 2e 20 20 42 |ic recep|tors. B|
|00003b20| 65 63 61 75 73 65 20 73 | 65 72 6f 74 6f 6e 69 6e |ecause s|erotonin|
|00003b30| 20 68 61 73 20 61 20 72 | 6f 6c 65 20 69 6e 0d 0a | has a r|ole in..|
|00003b40| 74 68 65 20 70 65 72 69 | 70 68 65 72 61 6c 20 63 |the peri|pheral c|
|00003b50| 69 72 63 75 6c 61 74 69 | 6f 6e 20 6f 66 20 70 61 |irculati|on of pa|
|00003b60| 74 69 65 6e 74 73 20 77 | 69 74 68 20 70 65 72 69 |tients w|ith peri|
|00003b70| 70 68 65 72 61 6c 20 76 | 61 73 63 75 6c 61 72 20 |pheral v|ascular |
|00003b80| 64 69 73 65 61 73 65 73 | 2c 20 61 0d 0a 72 61 6e |diseases|, a..ran|
|00003b90| 64 6f 6d 69 7a 65 64 2c | 20 64 6f 75 62 6c 65 2d |domized,| double-|
|00003ba0| 62 6c 69 6e 64 2c 20 63 | 6c 69 6e 69 63 61 6c 20 |blind, c|linical |
|00003bb0| 74 72 69 61 6c 20 77 61 | 73 20 69 6e 69 74 69 61 |trial wa|s initia|
|00003bc0| 74 65 64 20 74 6f 20 61 | 73 73 65 73 73 20 74 68 |ted to a|ssess th|
|00003bd0| 65 20 65 66 66 65 63 74 | 20 6f 66 0d 0a 61 20 32 |e effect| of..a 2|
|00003be0| 25 20 6b 65 74 61 6e 73 | 65 72 69 6e 20 6f 69 6e |% ketans|erin oin|
|00003bf0| 74 6d 65 6e 74 20 66 6f | 72 6d 75 6c 61 74 69 6f |tment fo|rmulatio|
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|00003c20| 63 65 72 73 2c 20 61 6e | 64 0d 0a 69 73 63 68 65 |cers, an|d..ische|
|00003c30| 6d 69 63 20 73 6b 69 6e | 20 75 6c 63 65 72 73 2e |mic skin| ulcers.|
|00003c40| 0d 0a 20 20 20 20 20 4f | 66 20 37 34 20 70 61 74 |.. O|f 74 pat|
|00003c50| 69 65 6e 74 73 2c 20 32 | 35 20 68 61 64 20 64 65 |ients, 2|5 had de|
|00003c60| 63 75 62 69 74 75 73 20 | 75 6c 63 65 72 73 2c 20 |cubitus |ulcers, |
|00003c70| 33 37 20 68 61 64 20 76 | 65 6e 6f 75 73 20 75 6c |37 had v|enous ul|
|00003c80| 63 65 72 73 2c 20 36 20 | 68 61 64 0d 0a 69 73 63 |cers, 6 |had..isc|
|00003c90| 68 65 6d 69 63 20 75 6c | 63 65 72 73 20 77 69 74 |hemic ul|cers wit|
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|00003cb0| 6e 64 20 36 20 68 61 64 | 20 69 73 63 68 65 6d 69 |nd 6 had| ischemi|
|00003cc0| 63 20 75 6c 63 65 72 73 | 20 77 69 74 68 20 64 69 |c ulcers| with di|
|00003cd0| 61 62 65 74 65 73 2e 0d | 0a 54 68 69 72 74 79 2d |abetes..|.Thirty-|
|00003ce0| 73 69 78 20 70 61 74 69 | 65 6e 74 73 20 28 6d 65 |six pati|ents (me|
|00003cf0| 61 6e 20 61 67 65 2c 20 | 36 35 20 79 65 61 72 73 |an age, |65 years|
|00003d00| 29 20 77 65 72 65 20 72 | 61 6e 64 6f 6d 6c 79 20 |) were r|andomly |
|00003d10| 61 73 73 69 67 6e 65 64 | 20 74 6f 20 74 72 65 61 |assigned| to trea|
|00003d20| 74 6d 65 6e 74 0d 0a 77 | 69 74 68 20 6b 65 74 61 |tment..w|ith keta|
|00003d30| 6e 73 65 72 69 6e 20 6f | 69 6e 74 6d 65 6e 74 20 |nserin o|intment |
|00003d40| 61 6e 64 20 33 38 20 70 | 61 74 69 65 6e 74 73 20 |and 38 p|atients |
|00003d50| 28 6d 65 61 6e 20 61 67 | 65 2c 20 36 38 20 79 65 |(mean ag|e, 68 ye|
|00003d60| 61 72 73 29 20 74 6f 20 | 70 6c 61 63 65 62 6f 2e |ars) to |placebo.|
|00003d70| 20 20 54 68 65 0d 0a 73 | 74 75 64 79 20 6c 61 73 | The..s|tudy las|
|00003d80| 74 65 64 20 66 6f 72 20 | 61 20 6d 69 6e 69 6d 75 |ted for |a minimu|
|00003d90| 6d 20 6f 66 20 32 20 77 | 65 65 6b 73 20 61 6e 64 |m of 2 w|eeks and|
|00003da0| 20 61 20 6d 61 78 69 6d | 75 6d 20 6f 66 20 38 20 | a maxim|um of 8 |
|00003db0| 77 65 65 6b 73 2e 20 20 | 4f 6e 65 0d 0a 70 6c 61 |weeks. |One..pla|
|00003dc0| 63 65 62 6f 2d 74 72 65 | 61 74 65 64 20 70 61 74 |cebo-tre|ated pat|
|00003dd0| 69 65 6e 74 20 61 6e 64 | 20 31 20 6b 65 74 61 6e |ient and| 1 ketan|
|00003de0| 73 65 72 69 6e 2d 74 72 | 65 61 74 65 64 20 70 61 |serin-tr|eated pa|
|00003df0| 74 69 65 6e 74 2c 20 62 | 6f 74 68 20 77 69 74 68 |tient, b|oth with|
|00003e00| 20 76 65 6e 6f 75 73 0d | 0a 75 6c 63 65 72 73 2c | venous.|.ulcers,|
|00003e10| 20 64 72 6f 70 70 65 64 | 20 6f 75 74 20 6f 66 20 | dropped| out of |
|00003e20| 74 68 65 20 73 74 75 64 | 79 2e 20 20 41 6c 6c 20 |the stud|y. All |
|00003e30| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 64 65 |patients| with de|
|00003e40| 63 75 62 69 74 75 73 20 | 75 6c 63 65 72 73 20 77 |cubitus |ulcers w|
|00003e50| 65 72 65 0d 0a 68 6f 73 | 70 69 74 61 6c 69 7a 65 |ere..hos|pitalize|
|00003e60| 64 20 61 74 20 74 68 65 | 20 74 69 6d 65 20 6f 66 |d at the| time of|
|00003e70| 20 74 72 65 61 74 6d 65 | 6e 74 2e 20 20 50 61 74 | treatme|nt. Pat|
|00003e80| 69 65 6e 74 73 20 77 65 | 72 65 20 73 63 6f 72 65 |ients we|re score|
|00003e90| 64 20 6f 6e 20 67 72 61 | 6e 75 6c 61 74 69 6f 6e |d on gra|nulation|
|00003ea0| 0d 0a 74 69 73 73 75 65 | 20 61 6e 64 20 65 70 69 |..tissue| and epi|
|00003eb0| 74 68 65 6c 69 61 6c 69 | 7a 61 74 69 6f 6e 20 6f |theliali|zation o|
|00003ec0| 6e 20 61 20 73 63 61 6c | 65 20 6f 66 20 30 2d 33 |n a scal|e of 0-3|
|00003ed0| 2e 0d 0a 20 20 20 20 20 | 41 66 74 65 72 20 32 20 |... |After 2 |
|00003ee0| 77 65 65 6b 73 20 6f 66 | 20 74 72 65 61 74 6d 65 |weeks of| treatme|
|00003ef0| 6e 74 20 74 68 65 20 61 | 76 65 72 61 67 65 20 63 |nt the a|verage c|
|00003f00| 6f 76 65 72 69 6e 67 20 | 6f 66 20 74 68 65 20 77 |overing |of the w|
|00003f10| 6f 75 6e 64 20 69 6e 0d | 0a 6b 65 74 61 6e 73 65 |ound in.|.ketanse|
|00003f20| 72 69 6e 2d 74 72 65 61 | 74 65 64 20 70 61 74 69 |rin-trea|ted pati|
|00003f30| 65 6e 74 73 20 77 61 73 | 20 73 69 67 6e 69 66 69 |ents was| signifi|
|00003f40| 63 61 6e 74 6c 79 20 62 | 65 74 74 65 72 20 74 68 |cantly b|etter th|
|00003f50| 61 6e 20 74 68 61 74 20 | 69 6e 0d 0a 70 6c 61 63 |an that |in..plac|
|00003f60| 65 62 6f 2d 74 72 65 61 | 74 65 64 20 70 61 74 69 |ebo-trea|ted pati|
|00003f70| 65 6e 74 73 2e 20 20 54 | 68 65 20 64 69 66 66 65 |ents. T|he diffe|
|00003f80| 72 65 6e 63 65 20 62 65 | 63 61 6d 65 20 65 76 65 |rence be|came eve|
|00003f90| 6e 20 6d 6f 72 65 20 70 | 72 6f 6e 6f 75 6e 63 65 |n more p|ronounce|
|00003fa0| 64 20 61 66 74 65 72 20 | 34 0d 0a 77 65 65 6b 73 |d after |4..weeks|
|00003fb0| 20 6f 66 20 74 72 65 61 | 74 6d 65 6e 74 20 61 6e | of trea|tment an|
|00003fc0| 64 20 70 65 72 73 69 73 | 74 65 64 20 74 68 72 6f |d persis|ted thro|
|00003fd0| 75 67 68 6f 75 74 20 74 | 68 65 20 73 74 75 64 79 |ughout t|he study|
|00003fe0| 2e 20 20 54 68 65 20 69 | 6e 69 74 69 61 6c 20 77 |. The i|nitial w|
|00003ff0| 6f 75 6e 64 20 61 72 65 | 61 0d 0a 69 6e 20 74 68 |ound are|a..in th|
|00004000| 65 20 6b 65 74 61 6e 73 | 65 72 69 6e 20 67 72 6f |e ketans|erin gro|
|00004010| 75 70 20 77 61 73 20 64 | 65 63 72 65 61 73 65 64 |up was d|ecreased|
|00004020| 20 62 79 20 35 30 25 20 | 61 66 74 65 72 20 32 2e | by 50% |after 2.|
|00004030| 36 20 77 65 65 6b 73 20 | 6f 66 20 74 72 65 61 74 |6 weeks |of treat|
|00004040| 6d 65 6e 74 2c 0d 0a 63 | 6f 6d 70 61 72 65 64 20 |ment,..c|ompared |
|00004050| 77 69 74 68 20 61 20 35 | 30 25 20 72 65 64 75 63 |with a 5|0% reduc|
|00004060| 74 69 6f 6e 20 69 6e 20 | 77 6f 75 6e 64 20 61 72 |tion in |wound ar|
|00004070| 65 61 20 6f 62 74 61 69 | 6e 65 64 20 61 66 74 65 |ea obtai|ned afte|
|00004080| 72 20 36 2e 36 20 77 65 | 65 6b 73 20 6f 66 0d 0a |r 6.6 we|eks of..|
|00004090| 70 6c 61 63 65 62 6f 20 | 74 72 65 61 74 6d 65 6e |placebo |treatmen|
|000040a0| 74 2e 20 20 4e 6f 20 73 | 74 61 74 69 73 74 69 63 |t. No s|tatistic|
|000040b0| 61 6c 20 64 69 66 66 65 | 72 65 6e 63 65 20 77 61 |al diffe|rence wa|
|000040c0| 73 20 6f 62 73 65 72 76 | 65 64 20 69 6e 20 74 65 |s observ|ed in te|
|000040d0| 72 6d 73 20 6f 66 0d 0a | 67 72 61 6e 75 6c 61 74 |rms of..|granulat|
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|000040f0| 7a 61 74 69 6f 6e 2c 20 | 6f 72 20 77 6f 75 6e 64 |zation, |or wound|
|00004100| 20 63 6c 6f 73 75 72 65 | 20 61 73 20 61 20 66 75 | closure| as a fu|
|00004110| 6e 63 74 69 6f 6e 20 6f | 66 20 74 68 65 0d 0a 70 |nction o|f the..p|
|00004120| 61 74 68 6f 67 65 6e 65 | 73 69 73 20 6f 66 20 74 |athogene|sis of t|
|00004130| 68 65 20 75 6c 63 65 72 | 2e 0d 0a 0d 0a 50 6f 73 |he ulcer|.....Pos|
|00004140| 74 2d 43 6f 6d 6d 65 6e | 74 0d 0a 0d 0a 20 20 20 |t-Commen|t.... |
|00004150| 20 20 54 68 69 73 20 69 | 73 20 61 20 76 65 72 79 | This i|s a very|
|00004160| 20 69 6d 70 72 65 73 73 | 69 76 65 20 73 74 75 64 | impress|ive stud|
|00004170| 79 2c 20 70 61 72 74 69 | 63 75 6c 61 72 6c 79 20 |y, parti|cularly |
|00004180| 61 73 20 69 74 20 6c 61 | 73 74 65 64 20 6f 6e 6c |as it la|sted onl|
|00004190| 79 20 66 6f 72 20 61 0d | 0a 6d 61 78 69 6d 75 6d |y for a.|.maximum|
|000041a0| 20 6f 66 20 38 20 77 65 | 65 6b 73 20 61 6e 64 20 | of 8 we|eks and |
|000041b0| 73 69 67 6e 69 66 69 63 | 61 6e 74 20 68 65 61 6c |signific|ant heal|
|000041c0| 69 6e 67 20 6f 63 63 75 | 72 72 65 64 20 64 75 72 |ing occu|rred dur|
|000041d0| 69 6e 67 20 74 68 61 74 | 20 74 69 6d 65 2e 20 20 |ing that| time. |
|000041e0| 4d 79 20 6f 6e 6c 79 0d | 0a 70 72 6f 62 6c 65 6d |My only.|.problem|
|000041f0| 20 77 69 74 68 20 74 68 | 65 20 73 74 75 64 79 20 | with th|e study |
|00004200| 64 65 73 69 67 6e 20 69 | 73 20 74 68 61 74 20 61 |design i|s that a|
|00004210| 20 62 6c 61 6e 64 20 63 | 6f 6e 74 72 6f 6c 20 73 | bland c|ontrol s|
|00004220| 75 62 73 74 61 6e 63 65 | 20 73 75 63 68 20 61 73 |ubstance| such as|
|00004230| 0d 0a 70 65 74 72 6f 6c | 61 74 75 6d 20 77 61 73 |..petrol|atum was|
|00004240| 20 6e 6f 74 20 75 73 65 | 64 2e 20 20 49 74 20 69 | not use|d. It i|
|00004250| 73 20 70 6f 73 73 69 62 | 6c 65 20 74 68 61 74 20 |s possib|le that |
|00004260| 74 68 65 20 76 65 68 69 | 63 6c 65 20 28 63 6f 6e |the vehi|cle (con|
|00004270| 74 72 6f 6c 20 73 75 62 | 73 74 61 6e 63 65 29 0d |trol sub|stance).|
|00004280| 0a 77 69 74 68 6f 75 74 | 20 6b 65 74 61 6e 73 65 |.without| ketanse|
|00004290| 72 69 6e 20 69 6e 68 69 | 62 69 74 73 20 77 6f 75 |rin inhi|bits wou|
|000042a0| 6e 64 20 68 65 61 6c 69 | 6e 67 20 61 6e 64 20 74 |nd heali|ng and t|
|000042b0| 68 65 20 65 66 66 65 63 | 74 20 69 73 20 6f 6e 6c |he effec|t is onl|
|000042c0| 79 20 74 68 61 74 20 6f | 66 0d 0a 73 75 73 70 65 |y that o|f..suspe|
|000042d0| 6e 64 69 6e 67 20 73 75 | 63 68 20 69 6e 68 69 62 |nding su|ch inhib|
|000042e0| 69 74 69 6f 6e 2e 20 20 | 49 20 61 67 72 65 65 20 |ition. |I agree |
|000042f0| 74 68 61 74 20 69 73 20 | 75 6e 6c 69 6b 65 6c 79 |that is |unlikely|
|00004300| 2e 20 20 49 74 27 73 20 | 74 6f 6f 20 62 61 64 20 |. It's |too bad |
|00004310| 74 68 61 74 20 6e 6f 0d | 0a 70 68 6f 74 6f 73 20 |that no.|.photos |
|00004320| 77 65 72 65 20 69 6e 63 | 6c 75 64 65 64 20 69 6e |were inc|luded in|
|00004330| 20 74 68 65 20 70 61 70 | 65 72 2e 20 20 49 20 6c | the pap|er. I l|
|00004340| 6f 6f 6b 20 66 6f 72 77 | 61 72 64 20 74 6f 20 6d |ook forw|ard to m|
|00004350| 6f 72 65 20 63 6f 6e 66 | 69 72 6d 61 74 6f 72 79 |ore conf|irmatory|
|00004360| 0d 0a 73 74 75 64 69 65 | 73 2e 2d 2d 4a 2e 43 2e |..studie|s.--J.C.|
|00004370| 20 41 6c 70 65 72 2c 20 | 4d 2e 44 2e 0d 0a 24 55 | Alper, |M.D...$U|
|00004380| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 30 39 33 30 |nique_ID|{YRB0930|
|00004390| 35 7d 0d 0a 24 54 69 74 | 6c 65 7b 4d 75 6c 74 69 |5}..$Tit|le{Multi|
|000043a0| 63 65 6e 74 65 72 20 54 | 72 69 61 6c 20 6f 66 20 |center T|rial of |
|000043b0| 43 61 64 65 78 6f 6d 65 | 72 20 49 6f 64 69 6e 65 |Cadexome|r Iodine|
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|00004410| 57 0d 0a 50 69 65 72 63 | 65 2c 20 47 45 7d 0d 0a |W..Pierc|e, GE}..|
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|00004440| 20 55 6e 69 76 20 6f 66 | 20 57 61 73 68 69 6e 67 | Univ of| Washing|
|00004450| 74 6f 6e 3b 20 56 69 72 | 67 69 6e 69 61 20 43 6f |ton; Vir|ginia Co|
|00004460| 6d 6d 6f 6e 77 65 61 6c | 74 68 20 55 6e 69 76 2c |mmonweal|th Univ,|
|00004470| 20 52 69 63 68 6d 6f 6e | 64 3b 20 55 6e 69 76 20 | Richmon|d; Univ |
|00004480| 6f 66 20 4b 61 6e 73 61 | 73 7d 0d 0a 24 4a 6f 75 |of Kansa|s}..$Jou|
|00004490| 72 6e 61 6c 7b 57 65 73 | 74 20 4a 20 4d 65 64 7d |rnal{Wes|t J Med}|
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|000044b0| 24 50 61 67 65 7b 33 35 | 2d 33 38 7d 0d 0a 24 44 |$Page{35|-38}..$D|
|000044c0| 61 74 65 7b 4a 75 6c 79 | 20 31 39 38 39 7d 0d 0a |ate{July| 1989}..|
|000044d0| 24 59 42 56 6f 6c 7b 31 | 39 39 30 20 59 65 61 72 |$YBVol{1|990 Year|
|000044e0| 20 42 6f 6f 6b 20 6f 66 | 20 44 65 72 6d 61 74 6f | Book of| Dermato|
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|00004500| 31 39 2d 37 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |19-7}..$|YBEditor|
|00004510| 7b 44 72 73 2e 20 53 6f | 62 65 72 20 61 6e 64 20 |{Drs. So|ber and |
|00004520| 46 69 74 7a 70 61 74 72 | 69 63 6b 7d 0d 0a 24 54 |Fitzpatr|ick}..$T|
|00004530| 61 62 6c 65 7b 7d 0d 0a | 24 43 6f 6d 6d 65 6e 74 |able{}..|$Comment|
|00004540| 61 74 6f 72 7b 4a 2e 43 | 2e 20 41 6c 70 65 72 2c |ator{J.C|. Alper,|
|00004550| 20 4d 2e 44 2e 7d 0d 0a | 0d 0a 43 6f 70 79 72 69 | M.D.}..|..Copyri|
|00004560| 67 68 74 20 28 63 29 20 | 59 65 61 72 62 6f 6f 6b |ght (c) |Yearbook|
|00004570| 20 4d 65 64 69 63 61 6c | 20 50 75 62 6c 69 73 68 | Medical| Publish|
|00004580| 65 72 73 2c 20 49 6e 63 | 2e 2c 20 31 39 39 30 0d |ers, Inc|., 1990.|
|00004590| 0a 0d 0a 31 39 39 30 20 | 59 65 61 72 20 42 6f 6f |...1990 |Year Boo|
|000045a0| 6b 20 6f 66 20 44 65 72 | 6d 61 74 6f 6c 6f 67 79 |k of Der|matology|
|000045b0| 20 28 52 29 0d 0a 0d 0a | 43 68 61 70 74 65 72 20 | (R)....|Chapter |
|000045c0| 31 39 2d 2d 56 61 73 63 | 75 6c 61 72 20 44 69 73 |19--Vasc|ular Dis|
|000045d0| 6f 72 64 65 72 73 0d 0a | 0d 0a 2d 2d 2d 2d 2d 2d |orders..|..------|
|000045e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004620| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 4d 75 6c 74 69 63 |--------|..Multic|
|00004630| 65 6e 74 65 72 20 54 72 | 69 61 6c 20 6f 66 20 43 |enter Tr|ial of C|
|00004640| 61 64 65 78 6f 6d 65 72 | 20 49 6f 64 69 6e 65 20 |adexomer| Iodine |
|00004650| 74 6f 20 54 72 65 61 74 | 20 56 65 6e 6f 75 73 20 |to Treat| Venous |
|00004660| 53 74 61 73 69 73 20 55 | 6c 63 65 72 0d 0a 0d 0a |Stasis U|lcer....|
|00004670| 48 6f 6c 6c 6f 77 61 79 | 20 47 41 20 4a 72 3b 20 |Holloway| GA Jr; |
|00004680| 4a 6f 68 61 6e 73 65 6e | 20 4b 48 3b 20 42 61 72 |Johansen| KH; Bar|
|00004690| 6e 65 73 20 52 57 3b 20 | 50 69 65 72 63 65 20 47 |nes RW; |Pierce G|
|000046a0| 45 0d 0a 28 48 61 72 62 | 6f 72 76 69 65 77 20 4d |E..(Harb|orview M|
|000046b0| 65 64 20 43 74 72 3b 20 | 55 6e 69 76 20 6f 66 20 |ed Ctr; |Univ of |
|000046c0| 57 61 73 68 69 6e 67 74 | 6f 6e 3b 20 56 69 72 67 |Washingt|on; Virg|
|000046d0| 69 6e 69 61 20 43 6f 6d | 6d 6f 6e 77 65 61 6c 74 |inia Com|monwealt|
|000046e0| 68 20 55 6e 69 76 2c 20 | 52 69 63 68 6d 6f 6e 64 |h Univ, |Richmond|
|000046f0| 3b 0d 0a 55 6e 69 76 20 | 6f 66 20 4b 61 6e 73 61 |;..Univ |of Kansa|
|00004700| 73 29 0d 0a 57 65 73 74 | 20 4a 20 4d 65 64 20 31 |s)..West| J Med 1|
|00004710| 35 31 3a 33 35 2d 33 38 | 2c 20 4a 75 6c 79 20 31 |51:35-38|, July 1|
|00004720| 39 38 39 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |989..---|--------|
|00004730| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004740| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004750| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004770| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|00004780| 0a 0d 0a 20 20 20 20 20 | 43 61 64 65 78 6f 6d 65 |... |Cadexome|
|00004790| 72 20 69 6f 64 69 6e 65 | 20 69 73 20 61 20 74 6f |r iodine| is a to|
|000047a0| 70 69 63 61 6c 20 70 6f | 6c 79 6d 65 72 69 63 20 |pical po|lymeric |
|000047b0| 73 74 61 72 63 68 20 62 | 65 61 64 20 73 69 6d 69 |starch b|ead simi|
|000047c0| 6c 61 72 20 74 6f 0d 0a | 64 65 78 74 72 61 6e 6f |lar to..|dextrano|
|000047d0| 6d 65 72 20 62 75 74 20 | 77 69 74 68 20 69 6f 64 |mer but |with iod|
|000047e0| 69 64 65 2c 20 30 2e 39 | 25 20 77 65 69 67 68 74 |ide, 0.9|% weight|
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|00004870| 20 69 6f 64 69 6e 65 20 | 62 65 63 6f 6d 65 73 20 | iodine |becomes |
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|000049c0| 74 72 65 61 74 6d 65 6e | 74 20 77 65 72 65 20 65 |treatmen|t were e|
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|00004a70| 20 49 6e 20 61 64 64 69 | 74 69 6f 6e 2c 0d 0a 74 | In addi|tion,..t|
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|00004bb0| 6d 0d 0a 63 61 64 65 78 | 6f 6d 65 72 20 69 6f 64 |m..cadex|omer iod|
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|00004ca0| 20 69 6f 64 69 6e 65 20 | 6d 61 79 20 62 65 20 61 | iodine |may be a|
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|00004ff0| 74 68 65 6c 69 61 6c 69 | 7a 61 74 69 6f 6e 20 6f |theliali|zation o|
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|00005020| 72 2c 20 4d 2e 44 2e 0d | 0a 24 55 6e 69 71 75 65 |r, M.D..|.$Unique|
|00005030| 5f 49 44 7b 59 52 42 30 | 39 33 30 36 7d 0d 0a 24 |_ID{YRB0|9306}..$|
|00005040| 54 69 74 6c 65 7b 4d 61 | 6c 69 67 6e 61 6e 74 20 |Title{Ma|lignant |
|00005050| 46 69 62 72 6f 75 73 20 | 48 69 73 74 69 6f 63 79 |Fibrous |Histiocy|
|00005060| 74 6f 6d 61 3a 20 20 41 | 20 4e 65 77 20 43 6f 6d |toma: A| New Com|
|00005070| 70 6c 69 63 61 74 69 6f | 6e 20 6f 66 20 43 68 72 |plicatio|n of Chr|
|00005080| 6f 6e 69 63 20 56 65 6e | 6f 75 73 20 55 6c 63 65 |onic Ven|ous Ulce|
|00005090| 72 61 74 69 6f 6e 7d 0d | 0a 24 41 75 74 68 6f 72 |ration}.|.$Author|
|000050a0| 7b 42 65 72 74 68 2d 4a | 6f 6e 65 73 2c 20 4a 0d |{Berth-J|ones, J.|
|000050b0| 0a 47 72 61 68 61 6d 2d | 42 72 6f 77 6e 2c 20 52 |.Graham-|Brown, R|
|000050c0| 41 43 0d 0a 46 6c 65 74 | 63 68 65 72 2c 20 41 0d |AC..Flet|cher, A.|
|000050d0| 0a 48 65 6e 64 65 72 73 | 6f 6e 2c 20 48 50 0d 0a |.Henders|on, HP..|
|000050e0| 42 61 72 72 69 65 2c 20 | 57 57 7d 0d 0a 24 41 66 |Barrie, |WW}..$Af|
|000050f0| 66 69 6c 69 61 74 69 6f | 6e 7b 4c 65 69 63 65 73 |filiatio|n{Leices|
|00005100| 74 65 72 20 52 6f 79 61 | 6c 20 49 6e 66 69 72 6d |ter Roya|l Infirm|
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|000052c0| 4d 61 6c 69 67 6e 61 6e | 74 20 46 69 62 72 6f 75 |Malignan|t Fibrou|
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|000052e0| 20 41 20 4e 65 77 20 43 | 6f 6d 70 6c 69 63 61 74 | A New C|omplicat|
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|00005400| 0a 0d 0a 20 20 20 20 20 | 4d 61 6c 69 67 6e 61 6e |... |Malignan|
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|00005d60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|00005df0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005e20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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