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Biomedical subjects

J D Holmes

Publications and source records attributed to J D Holmes.

36 records · Page 2Linked to original sources
PubMed1989

Capsular contracture after breast reconstruction with tissue expansion.

Tissue expansion before placement of an implant for breast reconstruction is said to lessen the chance of capsular contracture. Forty-nine patients who had undergone post-mastectomy breast reconstruction using tissue expansion were reviewed. Capsular contracture was assessed using the Baker scale and compared with the speed of expansion, the degree of over-expansion and the interval between full expansion and placement of the definitive prosthesis. The overall incidence of capsular contracture (Baker III or worse) was 29%. Only one patient, however, has required capsulotomy for capsular contracture alone. Neither the speed of expansion nor the degree of over-expansion influenced the onset of contracture. Those patients with breasts assessed in Baker group I had a significantly longer interval between full expansion and reconstruction than those in Baker group III (p = 0.05). A modification of Baker's scale is suggested for the assessment of reconstructed breasts. Prospective studies are required to define the optimum timing for tissue expansion procedures.

Adult↗
PubMed1987

The treatment of deep dermal burns by abrasion.

Deep dermal burns usually heal by a combination of epithelialisation and granulation tissue formation, and may form hypertrophic scars. Sometimes, however, they heal spontaneously and early with no hypertrophy. Early tangential excision and grafting is practised by many surgeons for these burn wounds, but, because of the problems of diagnosis and therefore the risks of unnecessary surgery, we have practised a policy of abrasion of burn wounds unhealed at two weeks after injury. The wounds were over-grafted or not depending on the appearance of the remaining dermis. Healing was generally rapid. Long term results show good scar formation with few problems from scar hypertrophy or contracture.

Burns↗
PubMed1986

Abdominal wound perfusion for the relief of postoperative pain.

In a double-blind trial, 50 patients with subcostal incisions performed for cholecystectomy or splenectomy, received 10 ml of either 0.5% bupivacaine plain or physiological saline twice daily by wound perfusion through an indwelling drainage tube for 3 days after operation. Analgesia, assessed by visual analogue score (VAS) and forced vital capacity (FVC), was significantly improved after perfusion with bupivacaine. Perfusion with physiological saline produced an analgesic effect comparable to that of bupivacaine as indicated by improvement in VAS. There was, however, no improvement in FVC, and opioid requirements were greater, in the patients whose wounds had been perfused with saline.

Adolescent↗
PubMed1984

The technique of late dermabrasion for deep dermal burns. Implications for planning treatment.

Deep dermal burns can be induced to epithelialize rapidly, and, therefore, heal by abrasion at about day 14 after injury. Hypertrophic scarring does not occur after such healing. If necessary, meshed skin graft can be applied at operation. Reduced blood loss, safe graft-take, smaller donor areas and avoidance of unnecessary surgery are all advantages of the method and make it a feasible alternative to early tangential excision and grafting.

Burns↗
PubMed1983

A hypothesis of the healing of deep dermal burns and the significance for treatment.

Deep dermal burns heal by a combination of new connective tissue formation (granulation) and epithelialization. In deep dermal wounds, which are unhealed after 14 days of conservative treatment, epithelialization can be enhanced by abrasion either alone or combined with provision of a skin graft. Some 42 burn wounds in 25 patients treated by this method have healed quickly and with good results. This method represents a move away from the current trend of early tangential excision and grafting of burn wounds and raises the possibility of developing a regime with the advantages but not the disadvantages of early tangential excision and grafting.

Burns↗
PubMed1977

Prescribing information in drug advertisements.

The need for continuing education in clinical pharmacology for practising doctors is seen in the light of a study of the prescribing information contained in recent New Zealand drug advertisements. Less than half of the advertisements contained details of dosage and only a quarter mentioned toxic effects.

Advertising↗
PubMed1977

Drug costs.

Explore the source record for details and available documents.

Advertising↗
PubMed1974

Prescribing patterns and morbidity in a tropical practice.

A retrospective study of morbidity and prescribing habits in a tropical practice is presented. The common symptoms of pain, cough, and fever accounted for 60 per cent of all cases seen while analgesics accounted for 30 per cent of all drugs prescribed.

Drug Prescriptions↗
PubMedDate not supplied

Delay between expansion and expander/implant exchange in breast reconstruction--a prospective study.

It has been suggested that delay between expansion and insertion of the definitive prosthesis in breast reconstruction reduces the incidence of adverse capsular contracture. We have carried out a prospective trial to examine this hypothesis. 65 patients were randomly allocated into two groups; in one, insertion of the definitive prosthesis was 2 weeks following expansion ("immediate") and in the other, 6 months ("delayed"). The incidence of adverse capsular contracture assessed both by the Baker Scale and a linear analogue scale showed no difference between the two groups. A new objective method for measuring ptosis using a specially designed template is described. The degree of ptosis was not affected by the delay.

Adult↗
PubMedDate not supplied

Skin injuries afflicting three oil workers following contact with calcium bromide and/or calcium chloride.

Calcium bromide brine is a highly concentrated aqueous solution of calcium bromide and calcium chloride. It is used extensively in the oil industry. This solution and its components are recognized as causes of skin injury and information is available from the manufacturers on their safe use and handling. Two patients who were injured following unprotected skin exposure to this solution and one patient who was injured following exposure to calcium chloride powder are reported. All sustained skin injuries characterised by an absence of pain and a delayed clinical appearance of the full extent of the injury. Furthermore healing was complicated by graft loss or was slow. Although organic bromine compounds are recognized as a cause of skin injuries, no previous reports of such injuries to humans secondary to calcium chloride or bromide exposure were found in the medical literature. Our experience with these patients is described.

Adult↗