Biomedical subjects
Publications and source records attributed to J J Petry.
Herbal medicines typically contain a number of active components. As a result, some provide multiple benefits and some a mixture of benefits and adverse effects. Hawthorn, kava, and saw palmetto fall into the first category and licorice into the second. The problems with licorice can be largely avoided by using a deglycyrrhizinated preparation.
Many herbal medicines have been used for centuries but have only recently been subjected to rigorous scientific scrutiny. Fever-few, milk thistle, tea tree oil, and valerian are considered safe for use by most patients. All four appear to provide some benefits in treating or preventing illness, but the supporting evidence is inconclusive in some cases.
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The incorporation of complementary therapies into the surgical setting has been slow compared to that of other areas of conventional medicine. This paper summarizes the available information on complementary therapies in surgery from a broad range of sources in the medical literature. The effects of psychological distress on the surgical patient and potential relief from that distress by such methods as relaxation techniques, hypnosis, suggestion, and imagery, as well as the role of coping style and locus of control on choice of therapy are reviewed. The role of acupuncture, music, massage therapy, therapeutic touch, and Reiki, as well as the use of herbs and supplements in modifying surgical outcome, is explored.
Used for centuries as folk remedies, herbs are enjoying a surge of public interest. Some empiric findings have been supported by formal research results. In order to advise patients about such preparations, physicians need to be aware of the indications, contraindications, drug interactions, and potential side effects. Eight popular herbs are reviewed.
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Surgical team members should be aware of which nutritional supplements may be harmful or helpful to surgical patients. Informed education of patients may prevent bleeding problems, wound-healing problems, prolonged hematomas, and dangerous immune system depletion.
This is not an exhaustive study of all nutritional supplements that patients may be taking. The most frequently used and those potentially most detrimental or most beneficial for surgical patients have been chosen for review of pertinent effects. It is essential to ask patients specifically about supplements or unusual dietary habits that may affect their surgical outcome prior to their invasive procedure and to keep in mind the supplements that may improve their outcome.
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Full thickness wounds, one on either side of the backs of rabbits, were covered with meshed or non-meshed split thickness skin grafts. The wounds were measured over a 3 month period and the minimum and maximum sizes of the wounds determined as well as the rate of growth. Wounds covered with meshed grafts contracted to 55% of the original size while those covered with non-meshed grafts contracted to 81.5% (p = less than 0.0001). The meshed wounds grew to 114.6% of original area and non-meshed grew to 153.3% (p = 0.035) after 13 weeks.
The effect of the "milking patency test" on the arterial endothelium of the experimental rat is investigated. Each of 18 rats served as its own control. Bilateral femoral artery anastomoses were performed in identical fashion. The milking patency test was performed on one side (experimental) but not on the other (control). After removal of the approximator clamps, rats were perfusion-fixed in situ. Harvested experimental vessels stained with silver showed a twofold increase in endothelial cell loss compared to controls. Visual evidence of extensive endothelial loss was seen on silver-stained segments in the tested area. This was corroborated by scanning electron microscopy. The degree of damage seen in this study suggests that the milking patency test is too traumatic for use in clinical microsurgery.
Six posterior calf fascial free flaps were employed to reconstruct defects of the upper and lower extremities. One flap failed due to a constricting dressing. Two flaps sustained partial loss secondary to bleeding and hematoma formation. One flap dehisced at the distal suture line due to mobility of an underlying fracture. All surviving flaps eventually healed and resulted in stable, thin coverage. Donor-site morbidity has been minimal. Shortcomings of this flap model have been defined in the peculiarities of its thinness, diffuse vascular oozing, the extent of the vascular territory, and in postoperative monitoring. These problems are analyzed and recommendations for their resolution are presented. Fascia represents a unique tissue which offers an exciting new dimension in the reconstruction of certain defects--particularly those in which thinness is a desirable option. In the posterior calf model, the inclusion of fat represents an alternative modification that allows the surgeon to tailor the design to a variety of problems where fascia alone is too thin and a cutaneous flap is too thick. This concept may find its greatest application in wounds involving the hand or foot. We believe that this and other fascial flap prototypes may offer an ideal solution for reconstruction of major wounds of the extremities.