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Biomedical subjects

C Weinstein

Publications and source records attributed to C Weinstein.

At least 19 recordsLinked to original sources
PubMed2001

Performance and error analysis of automated external defibrillator use in the out-of-hospital setting.

STUDY OBJECTIVE: We determined whether automated external defibrillators (AEDs) can meet the American Heart Association performance criteria to detect and shock unstable cardiac rhythms (ventricular fibrillation [VF], ventricular tachycardia [VT]) in the setting of an out-of-hospital cardiac arrest. METHODS: AED performance was reviewed for cardiac arrests occurring between January 1, 1995, and December 31, 1997. After every cardiac arrest, data regarding each rhythm analyzed and subsequent response (shock or no shock) were downloaded from the AED memory module. The study paramedic and study physician independently reviewed each case and interpreted cardiac rhythms from downloaded AED data. The emergency medical services medical director resolved all discrepancies in a blinded manner. All cases of out-of-hospital cardiac arrest in which an AED was turned on and a rhythm analyzed were included. The primary objective was the correct identification and defibrillation of VF or VT. Sensitivity, specificity, and predictive values with 95% confidence intervals (CIs) were calculated. Sources of error in AED rhythm management are also described. RESULTS: A total of 3,448 AED rhythms were available for interpretation. Sensitivity and specificity for appropriate AED management of a shockable (VF or VT) rhythm were 81.0% (95% CI 77.9% to 83.8%) and 99.9% (95% CI 99.7% to 100%), respectively. Positive and negative predictive values were 99.6% (95% CI 98.7% to 99.9%) and 95.5% (95% CI 94.7% to 96.2%), respectively. There were 132 errors associated with AED management. Two errors resulted in delivery of an inappropriate shock. In the remaining 130 errors, a shockable rhythm was not shocked. Fifty-five (42.3%) errors were AED dependent, 70 (53.9%) were operator dependent, and 5 (3.9%) were unclassified. CONCLUSION: The AED had high specificity and moderately high sensitivity in detecting and shocking unstable cardiac rhythms in the out-of-hospital setting. Few cardiac rhythms were mismanaged by the AED. Elimination of operator-dependent errors could increase AED sensitivity.

Boston↗
PubMed2001

Combined erbium:YAG laser resurfacing and face lifting.

Facial aging occurs secondary to gravity-induced tissue ptosis and photoaging. Combined face lifting and carbon dioxide laser resurfacing provides a comprehensive one-stage approach to facial rejuvenation but is condemned by many plastic surgeons due to the nonspecific thermal effects of the laser and risk of skin necrosis. Newer high-energy erbium:YAG lasers allow precise tissue ablation with minimal thermal effect. In this study, various facial rejuvenation techniques were combined with simultaneous erbium:YAG laser resurfacing to assess results and complications. A total of 257 patients from Florida, Melbourne, Australia, and Tel Aviv, Israel, underwent combined erbium:YAG laser resurfacing and surgical facial rejuvenation. Various face-lift methods were used, including endoscopic, deep plane, and subcutaneous. Simultaneous, full-facial laser resurfacing was performed using a variety of erbium:YAG lasers. It was found that combined laser resurfacing and face lifting was successful in greater than 95 percent of patients with minimal morbidity. Two patients (1 percent) (both heavy smokers) developed small areas of skin necrosis that healed with minor pigment changes. Five patients (2 percent) developed synechia that was treated with no residual effect. Two additional patients (1 percent) developed temporary ectropion. There were no other cases of scarring, infection, or cosmetically obvious hypopigmentation. Although larger studies are necessary, it seems that the lack of thermal injury from the erbium:YAG laser makes it possible to safely perform laser resurfacing with surgical facial rejuvenation in nonsmokers. However, the authors caution that familiarity with the nuances of erbium:YAG laser resurfacing be obtained before performing combined laser resurfacing and face lifting.

Adult↗
PubMed2000

Postoperative laser care.

Postoperative laser care is critical to the successful performance of CO2 and erbium laser resurfacing. Anticipation and prevention of postoperative problems and complications leads to greater patient satisfaction and fewer permanent sequalae. In most situations, a team approach, with the use of trained nurses and aestheticians, ensures greater success in this critical postoperative period. Laser resurfacing is one of the few procedures in which the surgery is only beginning when the surgeon leaves the operating suite.

Face↗
PubMed2000

Simultaneously combined ER:YAG and carbon dioxide laser (derma K) for skin resurfacing.

The simultaneously combined Er:YAG and carbon dioxide laser is ideally suited for treating deeper wrinkles with greater accuracy than either laser alone. By combining the precise ablative properties of the Er:YAG laser with the coagulative properties of the carbon dioxide laser, it is possible to control the depth of skin resurfacing to minimize complications and improve difficult and substantial wrinkles.

Aged↗
PubMed1999

Erbium laser resurfacing: current concepts.

Laser skin resurfacing has enjoyed great popularity in recent years with the introduction of computerized, pulsed carbon dioxide lasers. However, the morbidity and side effects of carbon dioxide lasers have stimulated a search for alternative methods of skin remodeling. The erbium:YAG laser can be successfully used for skin resurfacing, with lower morbidity than the carbon dioxide laser. In a series of 625 patients who had erbium:YAG resurfacing, the following conclusions were reached. (1) Long-term (> 6 months) improvement in wrinkles and acne scars required total fluences exceeding 20 J/cm2. Periocular wrinkles required total fluences of between 20 and 40 J/cm2, depending on the depth of the wrinkles and skin thickness. Perioral rhytids required total fluences of between 40 and 80 J/cm2, whereas the cheeks and forehead required total fluences of 30 to 60 J/cm2. (2) Deeper wrinkles were best treated with a combination of erbium and carbon dioxide lasers, which minimized the bleeding that occurs with deeper erbium resurfacing. The simultaneous combined erbium with carbon dioxide laser was particularly advantageous. (3) Complications were relatively uncommon using the scanning erbium laser, and most adverse effects occurred early in the series. Scarring occurred in 5 of the 625 patients (0.8 percent) and mostly resolved with intralesional steroids. Hyperpigmentation occurred in 21 of the 625 patients (3.4 percent) and was temporary in nature. Hypopigmentation, which became evident after 6 months, occurred in 25 of the 625 patients (4.0 percent) but was mild and not a significant cosmetic problem, except in one patient who developed scarring on the neck. Hypopigmentation seemed to be related to the depth of resurfacing. Four of the 625 patients (0.6 percent) developed temporary scleral show, but no patients had permanent ectropion. Eight of the 625 (1.3 percent) developed synechiae under the lower eyelid, which required minor correction.

Acne Vulgaris↗
PubMed1999

Modulated dual mode erbium/CO2 lasers for the treatment of acne scars.

BACKGROUND: Treatment of acne scarring is a challenging problem for dermatologists and cosmetic surgeons. Combining skin resurfacing with other procedures, especially the use of filling agents, has proven to be superior to the use of a single modality. Carbon dioxide laser resurfacing has been popularized for the treatment of acne scarring, but post operative morbidity with stimulation of active acne has been problematic. Conventional erbium resurfacing is effective when sufficient fluences are used, particularly when treating relatively superficial acne scars. Deeper resurfacing for acne scars is difficult with erbium lasers, owing to bleeding and heavy exudation, which decreases ablation efficiency and makes 'end points' difficult to visualize. The newer modulated hybrid erbium/CO2 lasers (Derma K, ESC Sharplan, Yokneam, Israel) produce efficient ablation by the reduction of bleeding, yet at the same time incur little post operative morbidity. This is suitable for treating deeper acne scars, and may be combined with other procedures, e.g. fat grafting. Of particular importance is the lack of acne stimulation associated with the use of the erbium/CO2 hybrid lasers. RESULTS: In my series of 78 patients, improvement in acne scarring was > 70% in the majority of patients. Post operative morbidity and complications were minor compared to conventional CO2 laser resurfacing.

Acne Vulgaris↗
PubMed1998

Postoperative care following carbon dioxide laser resurfacing. Avoiding pitfalls.

Facial skin resurfacing using the carbon dioxide laser has become an increasingly popular procedure. Improvements in carbon dioxide laser technology have made the procedure simpler and more reliable. However, difficulties and problems in the postoperative period can lead to patient morbidity and physician anxiety. The authors have performed laser resurfacing in almost 2,000 patients in the last 4 years. Problems encountered and methods formulated to minimize postoperative complications are discussed.

Dermatologic Surgical Procedures↗
PubMed1998

Carbon dioxide laser resurfacing combined with endoscopic forehead lift, laser blepharoplasty, and transblepharoplasty corrugator muscle resection.

BACKGROUND: Endoscopic forehead lifting has become an increasingly popular method for rejuvenating the upper face, due to its less invasive nature and minimal scars. However, adequate ablation of frown muscles (i.e., corrugator and depressor supercili) is difficult with this approach. The frown muscles are in close proximity to the upper eyelid, and it is possible to oblate them via the blepharoplasty approach using the carbon dioxide laser. OBJECTIVE: The purpose of this paper is to describe the combined approach of endoscopic forehead lifting and carbon dioxide laser resurfacing to rejuvenate the upper face. The former technique addresses the issue of brow elevation and improvement of dynamic glabellar frown lines. The latter technique deals with static wrinkles caused by sun damage. METHODS AND RESULTS: Thirty-seven patients underwent endoscopic forehead lift, transblepharoplasty corrugator ablation, with simultaneous carbon dioxide laser resurfacing of forehead skin. Twenty-eight of 37 patients (76%) achieved excellent results, while nine of 37 (14%) experienced good results. Complications were minimal, being mostly due to inadequate corrugator muscle resection with recurrent frowning. There were no instances of scarring, skin necrosis, or permanent hair loss. CONCLUSION: The combination of endoscopic forehead lifting, transblepharoplasty corrugator muscle resection, and carbon dioxide laser resurfacing is an effective and safe technique for rejuvenating the upper face, producing a natural result with minimal complications.

Adult↗
PubMed1998

Computerized scanning erbium:YAG laser for skin resurfacing.

Laser skin resurfacing has become increasingly popular as a method of facial rejuvenation. Although carbon dioxide (CO2) laser resurfacing is extremely effective, there is considerable morbidity associated with this procedure. Erbium (Er):YAG lasers, like CO2 lasers, are highly absorbed by water, and are absorbed superficially in skin. In our study of 141 patients using the computerized scanning Er:YAG laser, we found that it was possible to precisely ablate skin with less thermal injury than the currently available scanning CO2 lasers. The scanning system allowed very precise and homogeneous skin ablation. It was possible to ablate epidermis and superficial dermis, although deeper resurfacing led to pinpoint bleeding. Furthermore, healing was more rapid than generally experienced using CO2 lasers. Erythema was less marked, and disappeared usually within 3-4 weeks. Histological studies confirmed the minimal degree of thermal injury, as was evident clinically. Fluences of at least 20 J/cm2 were necessary to produce new collagen formation.

Adult↗
PubMed1998

Carbon dioxide laser resurfacing. Long-term follow-up in 2123 patients.

Carbon dioxide (CO2) laser resurfacing has become increasingly popular as a method of facial rejuvenation, enabling the surgeon to repair sun-damaged skin, wrinkles, and acne scars precisely. This article presents the results of the authors' histologic studies with all of the current CO2 laser systems as well as the conclusions of her experience with 2123 patients over a 5-year period. Improvements obtained from CO2 laser resurfacing appear to be long lasting, especially when combined with other procedures, and it is likely that laser resurfacing will remain in the armamentarium of facial rejuvenation for some time.

Dermabrasion↗
PubMed1997

Postoperative care following CO2 laser resurfacing: avoiding pitfalls.

Facial skin resurfacing using the carbon dioxide laser has become an increasingly popular procedure. Improvements in carbon dioxide laser technology have made the procedure simpler and more reliable. However, difficulties in the postoperative period can lead to patient morbidity and physician anxiety. Common problems such as prolonged erythema, hyperpigmentation, acne, milia, dermatitis, and infection can be controlled or avoided with proper postoperative care. Less common sequela such as hypertrophic scarring and prolonged healing are often a results of errors committed in the postoperative period. The authors have performed laser resurfacing in almost 2100 patients in the last 4 years. Changes in the postoperative regimen to include no pretreatment, use of semipermeable dressings, antiviral and antibacterial prophylaxis, and early treatment with sunscreens and bleaching agents have made for a smoother recovery with more predictable results.

Antiviral Agents↗
PubMed1997

Aesthetic skin resurfacing with the high-energy ultrapulsed CO2 laser.

CO2 laser resurfacing, using the new generation high-energy output pulsed lasers, provides a highly accurate method of resurfacing and rejuvenating facial skin. Its applications are widespread and well accepted by the general population (Color Figs. 3 to 8). Complications may occur, which may be minimized through adequate laser training and appreciation of the mechanisms of skin healing.

Acne Vulgaris↗
PubMed1996

A model to assess the effectiveness of topical antipruritics.

A model has been developed to determine the effectiveness of topical antipruritics. It utilizes controlled, experimentally induced itch and has demonstrated the effectiveness of the direct action on cutaneous receptor sites of a topical anesthetic, benzocaine, in a topical antipruritic formulation, and has been used to differentiate between two effective topical antipruritics. Three studies are presented: The first study examined the reliability of the experimentally induced itch. Several indices of reliability were computed from the data of this first study. Cronbach's alpha was 0.92. Winer's theta also was 0.92. Simple test-retest reliability, computed at intervals of 29 min, 1 day, and 6-7 days, resulted in Pearson correlations of 0.84, 0.73, and 0.60, respectively. In the second study, the model differentiated statistically between the itch relief resulting from the topical application of a formulation with 6% benzocaine and the same formulation without benzocaine. The third study examined 2 known topical antipruritics: one containing 6% benzocaine and the other 1% hydrocortisone. Both topical antipruritics were found to relieve itch; however, the benzocaine antipruritic produced statistically significantly greater itch relief in more subjects than the hydrocortisone antipruritic at both 1 and 30 min after application. These results demonstrate that OTC antipruritics can be differentiated for effectiveness.

Administration, Topical↗
PubMed1994

Ultrapulse carbon dioxide laser removal of periocular wrinkles in association with laser blepharoplasty.

Removal of periocular wrinkles is a common yet difficult problem. There are many techniques currently available, all of which have some drawbacks. With the advent of new generation ultrapulse carbon dioxide lasers, skin can now be resurfaced successfully with minimal risk and side effects. In our study of 36 patients we assessed the benefit of using ultrapulse carbon dioxide (CO 2) laser to resurface the periorbital skin in association with transconjunctival lower lid CO 2 laser blepharoplasty. We found that 36/36 (100%) patients had good to excellent results. The incidence of side effects was very low. We also found that 2/36 (5.6%) of patients developed mild clinically insignificant hypopigmentation and 1/36 (2.8%) developed mild scarring, which resolved with one injection of triamanalone 10 mg/ml. No patients had hyperpigmentation. In addition, 1/36 (2.8%) patients developed transient ectropion, which resolved spontaneously in 6 weeks. We conclude that ultrapulse CO 2 laser is an excellent method for treating periocular wrinkle lines and can be readily performed in conjunction with a transconjunctival lower lid blepharoplasty.

Adult↗
PubMed1994

The modified buried vertical mattress suture. A new technique of buried absorbable wound closure associated with excellent cosmesis for wounds under tension.

BACKGROUND: Recent modifications of mattress suturing techniques have been reported producing rapid and effective skin eversion and excellent tensile strength while producing cosmetically elegant results. OBJECTIVE: Presented here is a new modification of the buried vertical mattress suture. Results employing this technique compared with conventional bi-layered wound closure are presented. METHODS: One hundred patients were analyzed in a double-blind randomized study where excision was carried out on benign pigmented lesions of the upper back. Fifty patients were treated by a conventional bi-layered closure technique while another 50 patients were treated by the newly described buried vertical mattress suture technique. Parameters of infection, hypertrophic scar/keloid formation, dehiscence, suture reaction, wound spread, and patient satisfaction were examined. RESULTS: The modified buried vertical mattress suture technique produced less hypertrophic scar/keloid formation (2% vs 16%) as well as less wound scar spread (6% vs 24%) compared with conventional bi-layered suturing techniques. In addition, it was associated with a high degree of patient satisfaction (96%). CONCLUSION: The modified buried dermal mattress suture technique produces excellent cosmetic results in closing elliptical excisions on thick dermal cutaneous anatomic areas under considerable wound tension. Its decreased requirement for postoperative wound care makes it an excellent alternative for patients living long distances from physician referral centers.

Cicatrix, Hypertrophic↗
PubMed1994

Migration of cultured vascular smooth muscle cells through a basement membrane barrier requires type IV collagenase activity and is inhibited by cellular differentiation.

The migration of vascular smooth muscle cells (VSMCs) from the tunica media to the neointima is a key event in the development and progression of many vascular diseases and a highly predictable consequence of mechanical injury to the blood vessel. In vivo, VSMCs are surrounded by and embedded in a variety of extracellular matrices (ECMs) that must be traversed during migration. One of the principal barriers to cell movement in the intact vessel is the basement membrane (BM) that surrounds each VSMC and separates the VSMC-containing medial cell layer from the endothelium. We have used a Boyden chamber to monitor the ability of VSMCs to degrade a BM barrier as they migrate toward a chemoattractant and to define the role of extracellular proteases in this process. We show that cultured VSMCs can migrate across a BM barrier and that this ability was dependent on the phenotypic state of the cell. VSMCs maintained in a proliferating or "synthetic" state readily migrated across a BM toward a chemoattractant, whereas the migration of serum-starved/differentiated VSMCs was suppressed by > 80% (P < .001). By use of a number of peptides that inhibit matrix metalloproteinase (MMP) activity, the migration of proliferating VSMCs across the BM barrier was inhibited by > 80% (P < .0001), whereas migration that occurred in the absence of the barrier was unaffected. Northern blotting and zymographic analyses indicated that 72-kD type IV collagenase (MMP2) was the principal MMP expressed and secreted by these cells. Accordingly, antisera capable of selectively neutralizing MMP2 activity also inhibited VSMC migration across the barrier without significantly affecting the migration of VSMCs in the absence of the barrier. Finally, MMP2 activity was also regulated by the phenotypic state of the cells in that MMP2 activity expressed by serum-starved/differentiated VSMCs was < 5% of that measured in proliferating VSMCs. Extrapolating to the in vivo situation in which VSMCs reside in an ECM composed of various BM barriers, these results suggest that VSMC migration in vivo may be dependent on MMP2 activity. That activity, in turn, could be regulated by the phenotypic state of VSMCs and increase as these cells undergo the transition from a quiescent and differentiated state to that of a dedifferentiated, proliferating, and motile phenotype after injury to the vessel.

Animals↗
PubMed1992

A survey of long-term care elderly patients in the South West Thames Region.

This paper describes a survey which focuses on the patients in National Health Service long-term care beds. It examines the dependency levels and mental impairment of geriatric patients in 15 Departments of Geriatric Medicine, and determines the extent and distribution of patient dependency, including the number of independent patients. The findings support the view that there is a need for National Health Service long-term care beds.

Activities of Daily Living↗