Harvesting iliac bone.
Explore the source record for details and available documents.
Bone Transplantation↗
Biomedical subjects
G M Sloan
Publications and source records attributed to G M Sloan.
Distinguishing soft-tissue hemangiomas from vascular malformations using technetium-labeled red blood cell scintigraphy.
Soft-tissue vascular lesions in children can be classified as either hemangiomas or vascular malformations. The distinction between the two has important prognostic and therapeutic implications. Over the past 8 years, we have evaluated 64 vascular lesions with the technetium-labeled red blood cell (Tc-RBC) scan. Twenty-eight lesions imaged as hemangiomas with intense focal uniform uptake. This diagnosis was confirmed in 27 lesions, or 96 percent. Thirty-six lesions imaged as vascular malformations with abnormal vessels or diffusely increased activity. This diagnosis was confirmed in 35 lesions, or 97 percent. Overall, the Tc-RBC scan was 97 percent accurate in distinguishing hemangiomas from vascular malformations. It is particularly useful when the clinical diagnosis of the lesion may not be evident. Not only can biopsy be avoided, but parents can be reassured at an earlier age and given accurate information regarding prognosis.
Arteriovenous Malformations↗
Efficacy of debridement and primary closure of contaminated wounds: a comparison of methods.
Proper management of highly contaminated traumatic wounds frequently requires delayed primary closure of healing by secondary intention to prevent subsequent infection. This animal study compares the efficacy of various wound debridement methodologies to prevent infection following primary closure of treated contaminated wounds. Forty-four Sprague-Dawley rats with uniform, paravertebral incisions were studied. Each wound was inoculated with a standard amount of Staphylococcus aureus bacteria and allowed to remain open for two hours. Each wound was treated before wound closure by one of four debridement methods: (1) surgical scrubbing, (2) high-pressure irrigation, (3) ultrasonication, or (4) soaking. The control animals' wounds were closed without debridement. At 7 days, each animal was evaluated for the presence of gross infection and wound induration. Ultrasound, with a 25% incidence of gross infection, compared with irrigation (75%), scrubbing (82%), and soaking (89%) provided significant protection from subsequent abscess formation. The control group uniformly developed infection (100%). The average amount of induration after ultrasonication (1.35 +/- 0.56 cm) was also significantly less than irrigation (2.07 +/- 0.75 cm), scrubbing (1.95 +/- 0.34 cm), and soaking (1.73 +/- 0.22 cm). Our data demonstrate that ultrasonic wound debridement has exciting potential as a new debridement technique for contaminated traumatic wounds.
Animals↗
Intralesional corticosteroid therapy for infantile hemangiomas.
Intralesional corticosteroid injections were performed in 31 hemangiomas in 30 infants aged 1 to 10 months at first injection. One to five injections were given, spaced 6 weeks apart. Lesions were located throughout the head and neck region, except one that was on the buttock. A mixture of betamethasone acetate and triamcinolone acetonide was used. Four lesions (13 percent) virtually disappeared, ten (32 percent) showed greater than 50 percent reduction in volume, ten (32 percent) showed definite but less than 50 percent reduction in volume, and seven (23 percent) showed little or no decrease in size. None showed further growth. All injections were performed without anesthesia, and there were not significant complications. We conclude that intralesional corticosteroid injections are safe and effective in properly selected infants with hemangiomas.
Betamethasone↗
The external oblique myocutaneous flap for extended hemipelvectomy reconstruction.
This article documents the first case report of an extended hemipelvectomy defect closure using an ipsilateral external oblique myocutaneous flap. When a hemipelvectomy usually is performed for soft tissue tumor ablation, an anterior or posterior flap can be preserved for immediate coverage of vital structures. When these flaps are also resected to obtain clear tumor margins, closure becomes difficult. In our patient, although the rectus myocutaneous flap was a next logical choice, prior surgical scars precluded it use. The external oblique flap was successfully rotated and solved a difficult problem. This flap should be considered when the rectus abdominis myocutaneous flap is unavailable for extended hemipelvectomy closures.
Abdomen↗
Radionuclide-labeled red blood cell imaging of vascular malformations in children.
Vascular malformations, particularly in the absence of cutaneous changes, can be difficult to distinguish from other soft tissue masses in children. We have used technetium-99m-labeled red blood cell scintigraphy to study 47 lesions in 43 children. Thirty-nine lesions showed increased flow and were, therefore, diagnosed as vascular malformations. Subsequent biopsy of 10 of these lesions confirmed that diagnosis. The other 29 lesions with increased flow were followed for 10 months to 5 years and the clinical course was consistent with vascular malformation in every case. Eight lesions showed no increased flow on technetium scan. One of these subsequently proved to be a hemangioma. The others have turned out not to be vascular malformations. Therefore, in our experience, the technetium-99m-labeled red blood cell scan has had 98% sensitivity and 100% specificity in diagnosing vascular malformations in children.
Adolescent↗
An efficient device to collect bone dust.
An efficient and simple method for collection of bone dust during surgical procedures is presented.
Bone Transplantation↗
Massive subgaleal hematoma resulting in skin compromise and airway obstruction.
Subgaleal hematomas following minimal trauma, haircombing, and hair pulling by playground swings have been described. Recently a case was reported that progressed to otic hemorrhage and upper facial edema. We present a case (of a previously unreported nature) of a subgaleal hematoma that resulted in airway obstruction, massive edema of the entire face and neck, and limited epidermolysis of facial skin.
Airway Obstruction↗
Hair-thread tourniquet syndrome .
We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients with toe injuries and synthetic fibers from mittens in the finger cases. All six patients were treated by immediate removal of the constricting fibers, and, in spite of the worrisome appearance of the tissue distal to the constriction, all six eventually healed without significant tissue loss. A review of the literature indicated 60 similar cases of this type reported, 24 involving toes, 14 involving fingers, and 22 involving genitals. The majority of the toe and external genitalia cases were caused by hair, whereas the majority of finger strangulations were caused by thread from mittens. At greatest risk for strangulation are the middle finger and third toe, followed by the index finger and second toe. Patients with finger or penile involvement were more likely to suffer significant complications from the injuries than those patients with toe involvement. Based on our own experience and that described in the literature, we recommend prompt removal of the offending fiber, followed by prolonged conservative management of the damaged distal tissue, in the hope of maximal tissue salvage. Increased physician awareness of this syndrome is mandatory for prevention, diagnosis, and early treatment.
Clothing↗
A simple method for preventing misplaced electrocauterization.
A small segment of universally available and inexpensive rubber catheter can be easily fitted to insulate electrocautery tips. This technique can prevent numerous thermal injuries and potential litigation arising from accidently burning adjacent tissues. The routine use of this modification in the operating room can save time, anxiety, and potential litigation by preventing misplaced cauterization.
Electrocoagulation↗
Scalp infections in black children: think kerion.
Treatment of tinea capitis consists of a 5-week course of griseofulvin. A 1-week course of a systemic corticosteroid may be considered in addition to griseofulvin therapy to accelerate the subsidence of inflammation in kerion lesions. Kerion is an inflammatory form of tinea capitis which may progress rapidly into a fulminant infection if untreated. This case report underscores the need for prompt recognition and appropriate treatment of this disorder.
Abscess↗
Flap physiology and the prediction of flap viability.
Skin flaps are classified as random, axial, musculocutaneous, or fasciocutaneous according to the anatomy by which the skin receives its blood supply. The delay phenomenon allows larger and more reliable skin flaps to be transferred but requires additional surgical procedures. Efforts to mimic the delay phenomenon by pharmacologic means have, unfortunately, been disappointing. The major recent advances in flap design and reliability have come from increased knowledge of the anatomy of skin circulation, specifically musculocutaneous and fasciocutaneous circulation. In an effort to accurately predict flap survival, various monitoring techniques have been tried. These include visual inspection of fluorescein, fluorescein photography, dermofluorometry, surface temperature readings, photoplethysmography, ultrasound Doppler flowmeters, laser Dopplers, and transcutaneous PO2 monitors. Fluorescein has proved to be consistent and reliable, and the dermofluorometer has the advantage of using smaller fluorescein doses that can be frequently repeated. The other monitoring devices each have additional advantages and disadvantages.
Animals↗
Noninvasive monitoring of tissue viability.
Noninvasive monitoring techniques are procedures of little or no morbidity that may be repeated frequently to assess tissue viability. The ideal noninvasive technique would be safe, sensitive, reliable, reproducible, simple to use, and inexpensive. Although no such ideal technique yet exists, several currently available methods have clinical usefulness. Visual fluorescein, fluorescein photography, and surface fluorometry all work by the same principle. We prefer the surface fluorometer because of its greater sensitivity, the more objective nature of the data it provides, and the greater frequency with which it can be repeated. Ultrasound Doppler techniques are useful preoperatively in locating vessels and assessing their patency, and we have found the bidirectional Doppler quite helpful in the postoperative monitoring of replanted or revascularized digits. The laser Doppler, photoplethysmograph, and surface thermometer have not been as helpful in our experience. Transcutaneous oxygen measurement shows great promise for the postoperative monitoring of replants and free tissue transfers.
Animals↗
Epitrochlear node involvement in melanoma of the upper extremity.
Between 1955 and 1979, 240 patients with melanoma of the upper extremity were admitted to the National Institutes of Health (NIH). Thirty nine of these patients (16%) had primary lesions of the forearm, hand, or digit. Twenty-two patients underwent axillary dissection during their treatment. Ten patients were subjected to both axillary and epitrochlear lymph node dissection. Nine of these ten patients had lymph node metastases; two in the axillary nodes only, two in the epitrochlear nodes only, and five in both nodal groups. Epitrochlear node involvement occurred in 18% of patients with forearm or hand lesions, and only when the primary melanoma was within 5 cm of the elbow or in the ulnar distribution, the classically described drainage area of the epitrochlear nodes. The prognosis of the patients in this study was related to the depth of their primary lesions and the presence or absence of axillary node involvement. However, since approximately 18% of patients with melanomas of the hand, forearm and elbow area have a high probability of recurrence in the epitrochlear nodes, close attention to this area and early dissection of clinically suspicious nodes can favorably affect locoregional control in this group of melanoma patients.
Adult↗
Calcium and phosphorus metabolism during total parenteral nutrition.
Calcium and phosphorus metabolism and balance were studied in 151 patients receiving total parenteral nutrition (TPN). Hypercalciuria was common, with mean (+/- SD) urinary calcium excretion 17.5 +/- 3.9 meq/24 hours (n = 2610). There was a significant positive correlation between urinary calcium excretion and parenteral calcium intake (r = 0.34, p less than 0.001). There was also a positive correlation between calcium balance and parenteral calcium intake (r = 0.61, p less than 0.001) in patients without extra-renal losses. Positive calcium balance was achieved with parenteral calcium intake greater than 15 meq/24 hours. Urinary phosphorus excretion correlated positively with parenteral phosphorus intake (r = 0.50, p less than 0.001). Phosphorous balance also correlated positively with parenteral phosphorus intake (r = 0.78, p less than 0.001). Positive phosphorus balance was achieved with parenteral phosphorus intake above 15 mmol/24 hours. Fifty-three patients received 1,000 IU vitamin D once weekly and showed no significant change in serum calcium. Ninety-eight patients received 1,000 IU vitamin D twice weekly and showed a gradual but significant mean increase over time in serum calcium.
Adolescent↗
Inhibition of tumor size by streptozotocin-induced diabetes mellitus.
Explore the source record for details and available documents.
Animals↗
Nutritional effects of surgery, radiation therapy, and adjuvant chemotherapy for soft tissue sarcomas.
To determine the nutritional effects of aggressive combined modality cancer therapy, 35 consecutive patients undergoing surgery, radiation therapy, and adjuvant chemotherapy for soft tissue sarcomas of the head, neck, and trunk were prospectively studied. Changes in body weight, total protein, albumin, total lymphocyte count, and creatinine/height ratio were studied. Significant weight loss occurred with surgery, radiation therapy, and doxorubicin/cyclophosphamide, but not methotrexate, chemotherapy. Total protein and albumin did not change significantly with any of the individual therapies. On long-term follow-up (mean 27 months), patients who survived free of sarcoma showed little nutritional morbidity. Patients with progressive sarcoma, however, showed decreases of 9% in body weight (NS), 11% in total protein (p less than 0.01), 17% in serum albumin (p less than 0.05), and 64% in total lymphocyte count (p less than 0.02). These data indicate that aggressive combined modality cancer therapy can have significant acute nutritional effects. Long-term nutritional morbidity, however, is minimal in patients without recurrent disease. In contrast, patients with recurrent disease show severe nutritional deficits which seem more a consequence of the progressive disease than of the aggressive therapy.
Adolescent↗
Influence of diabetes mellitus and insulin treatment on protein turnover in the rat.
Explore the source record for details and available documents.
Animals↗