Biomedical subjects
Publications and source records attributed to A Neuman.
Congenital double lip is a rare entity. During the last 10 years, we performed surgery on 5 patients with this deformity. The patients are reported with a special mention of the embryology, and the relevant literature is reviewed.
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To absorb bleeding and pack the nasal cavities after rhinoplasty, a sterile commercial vaginal tampon was used. It has the following advantages: high absorbency, round configuration, and safety removal cord included to preclude gliding into the nasopharynx.
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The technique of burying small pieces of skin under old granulation tissue after recurrent failure of conventional skin grafting is described in a patient with 95 per cent full skin thickness burns. This method of treatment, which was described in the past and neglected, is of value for massive burns or grafting in difficult areas. The technique is described again and the relevant literature reviewed.
A 20-year-old soldier sustained 35 per cent body surface area burns by open flames. He was treated with topical application of 1 per cent silver sulphadiazine (SSD) twice daily. Four days postburn he developed acute haemolytic anaemia. Withdrawal of SSD was followed by complete recovery. A glucose-6-phosphate dehydrogenase (G6PD) deficiency was proven by pathological Motulski tests. Although the hazards of SSD are well indicated by the manufacturers, there appear to be no written reports of haemolysis induced by this drug in G6PD-deficient patients.
The increasing rate of breast reconstruction after modified radical mastectomy has led to the adoption of several techniques including transverse rectus abdominis musculocutaneous flap. Although the method creates a life-like breast both in texture and appearance, among other complications resulting from this operation, fat necrosis mimicking carcinoma on mammography clearly is common. We focus on the case history of 1 patient and detail our findings.
A simple method to ease the removal of stitches in hair-bearing areas is presented. The method consists of applying a depilatory cream to remove the masking hair.
The strange case of a 37-year-old modern, Western woman who presented with a giant black mass on her inner right thigh is presented. She was treated 10 months before this present admission by an excision of a nodular melanoma, and she was treated, thereafter, by a homeopathic practitioner until she came late to follow-up. The woman is discussed with special attention to the fact that alternative medicine does not always constitute good advice, and the relevant literature is reviewed.
The crystal of "methyl C-gentiobioside" (methyl 8,12-anhydro-6,7-dideoxy-D-glycero-D-gulo-alpha-D-gluco-trideca pyranoside) (C14H26O10) is triclinic, space group P1, with a = 1.0181 (6) nm, b = 0.8093 (5) nm, c = 0.5066 (4) nm, alpha = 96.03 (5) degrees, beta = 99.94 (5) degrees, gamma = 90.85 (5) degrees. The two D-glucose residues have the 4C1 conformation. The orientation of the beta-(1----6) linkage is characterized by torsion angles phi = 55.9 degrees, psi = 175.1 degrees, and omega = -63.9 degrees. The orientation of the primary hydroxyl group at the non-reducing residue is gauche-trans (omega' = -53.6 degrees). There is no intramolecular hydrogen bond. Molecules are held together by a network of hydrogen bonds involving all of the hydroxyl groups. This crystal structure is the first experimental characterization of a "C-disaccharide". Unlike methyl gentiobioside, which has a high level of conformational flexibility, the "C-disaccharide" has a restricted flexibility. Each of the low-energy conformers in vacuo has a value of phi centered about 60 degrees, in agreement with the solid state conformation, and the exo-anomeric effect is no longer predominant.
Digital hearing aids offer many advantages over conventional hearing aids. These include signal-processing capabilities that are superior to those of a conventional analog hearing aid, methods of signal-processing and control that are unique to digital systems and which cannot be implemented in conventional analog hearing aids, and innovative new techniques that are changing our way of thinking about hearing aids. An example of the first of these advantages is the extremely high precision with which the frequency-gain characteristic can be specified and the use of this capability to study the effects of frequency response irregularities commonly encountered with hearing aids. An example of the second advantage is the use of memory and logical operations in the implementation of multivariate adaptive paired-comparison techniques for more effective hearing-aid prescription. Another example is the use of powerful new signal processing techniques for noise reduction. The third advantage is the most important. The digital hearing aid can be viewed as a generalized hearing instrument which can be used for simulation, testing and prescription, as well as amplification. The use of the digital hearing aid as a simulator of other hearing aids is discussed and an illustrative example provided in which a new form of amplitude compression, orthogonal-polynomial compression, has been simulated using a digital master hearing aid.
A 16-month-old boy underwent oesophageal dilatations following an unsuccessful attempt to locally resect a 3 cm long lye stricture. He then developed a brain abscess which was surgically drained. Subsequently, a right colon interposition was performed to bypass the stricture. Following oesophageal dilatations, bacteraemia and fever are common but the occurrence of metastatic brain abscesses is rare. This serious complication should be kept in mind when long-term treatment by repeated oesophageal dilatations is planned.
The use of computer simulation in evaluating conventional and experimental hearing aids is described. Two illustrative examples are provided. The first involves the simulation of a conventional master hearing aid and its application in evaluating different adaptive strategies in the prescriptive fitting of hearing aids. The second example involves the simulation of an experimental hearing aid embodying modern digital signal-processing techniques for the reduction of background noise. A high-speed array processor is used in order to accomplish these simulations in real time.
Familial dysautonomia (FD) is a rare incurable genetic disorder with multisystem involvement. Most of its clinical manifestations are related to disorders of the autonomic nervous system. The disease is associated with specific disturbances of the upper gastrointestinal tract: pharyngoesophageal dyskinesia, gastroesophageal reflux, and prolonged gastric emptying. About 40% of the dysautonomic children manifest repeat vomiting crises. In view of the extensive gastrointestinal symptomatology, children with FD are prone to repeated aspiration pneumonia and chronic respiratory failure, while inadequate calory and fluid intake may lead to a chronic state of hypovolemia and severe failure to thrive. Control of vomiting, prevention of aspiration due to abnormal swallowing, and the assurance of adequate calory intake are three major objectives in the treatment of the dysautonomic child. Medical treatment of the gastrointestinal disorders using different drugs has had limited success. This study reviews the surgical experience in ten children with FD. The type of the procedure used was determined by the severity of the upper GI disturbances. Nine children underwent gastroesophageal Nissen fundoplication and gastrostomy. In seven of them, a pyloroplasty was added. Gastrostomy alone was done in one patient only. Postoperative complications included transient dysphagia in four patients, gastric dilatation in four patients, and dumping syndrome in one. There has been no incidence of immediate postoperative death. One child died 6 months after operation from severe and irreversible respiratory failure. Following operation, the patients still suffered from dysautonomic crises but these were not associated with vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)
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The usual indices of left ventricular systolic performance have been incapable of accurately recognizing early myocardial impairment in many patients treated with doxorubicin. Recently, several new load-independent, highly sensitive indices of left ventricular contractility have been developed including the slope value of the endsystolic pressure (Pes)-dimension (Des) relation and the position of the left ventricular end-systolic wall stress (sigma es)-percent fractional shortening (% delta D) relation. We used these indices to study 46 patients receiving either low dose or high dose doxorubicin. Results were compared with data from 30 healthy subjects. Resting % delta D failed to accurately recognize left ventricular dysfunction in 9 of 17 patients with low normal values. These patients had reduced afterload, as measured by sigma es, permitting normal extent of left ventricular fiber shortening despite impaired contractility as quantified by diminished Pes-Des slope values. There was 98% concordance between the relative position of the sigma es-% delta D relation and the slope value of the Pes-Des, relation. These indices offer an improved means of recognizing and quantitating impaired contractility in patients treated with doxorubicin.
A female newborn is presented with a Type I esophageal without a tracheoesophageal fistula. The distance between the ends of the esophageal pouches measured about four vertebrae. She was successfully managed by a primary esophagoesophagostomy following elongation of the upper pouch with esophageal bougies.