The problem with alternative remedies.
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Androstenedione↗
Biomedical subjects
J R Thomas
Publications and source records attributed to J R Thomas.
VRE: pay attention to your mom.
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Anti-Bacterial Agents↗
Alternative therapy.
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Complementary Therapies↗
Complications of the transconjunctival approach. A review of 400 cases.
OBJECTIVE: To review the intraoperative and postoperative complications of the transconjunctival approach, as well as their prevention, management, and outcomes. DESIGN: A retrospective study of the complications in 400 patients who underwent the transconjunctival approach to the lower eyelid or orbit for treatment of orbital trauma or the aging face. SETTING: Academic tertiary referral medical center. RESULTS: There were 8 cases of conjunctival granuloma, 2 cases of entropion, and 1 case each of hematoma, ectropion, prolonged chemosis, conjunctival inclusion cyst, lower eyelid laceration, and avulsion with lacrimal system injury. CONCLUSIONS: Complications of the transconjunctival approach are uncommon. When they do occur, proper management results in a successful outcome.
Adult↗
Clinical and histologic response of subcutaneous expanded polytetrafluoroethylene (Gore-Tex) and porous high-density polyethylene (Medpor) implants to acute and early infection.
OBJECTIVE: To examine the responses of subcutaneously implanted expanded polytetrafluoroethylene (e-PTFE, Gore-Tex) and porous high-density polyethylene (PHDPE, Medpor) to experimentally induced infection. DESIGN: Sprague-Dawley rats were implanted subcutaneously with either e-PTFE or PHDPE implants. Inocula of Staphylococcus aureus were injected directly over the implants and the wounds were observed for clinical signs of infection. After the animals were killed, the implants were harvested and underwent Histologic examination. SUBJECTS: Twenty-eight adult male Sprague-Dawley rats weighing 200 to 250 g. INTERVENTION: A 8-mm diameter, 1-mm-thick implant of either e-PTFE or PHDPE was placed in a subcutaneous pocket over each animal's dorsum. Either at the time of implantation or 14 days afterward, an inoculum of 10(9) colony-forming units of S aureus was injected transcutaneously directly over each implant. The animals were observed for 7 days before being killed. The implants were harvested and examined by both conventional light and scanning electron microscopy, and the degree of capsule reaction, infection, inflammation, and implant degradation was evaluated. RESULTS: Implants inoculated at the time of implantation were more likely to become clinically infected. Results for e-PTFE and PHDPE implants were similar in this group (5 of 5 e-PTFE and 5 of 5 PHDPE implants infected). The PHDPE implants inoculated 14 days after implantation were less likely to become infected (1 of 4 infected) than e-PTFE implants (3 of 4 infected), and were statistically less likely to become infected than PHDPE implants inoculated immediately after implantation (25% vs 100%; P < .02). Histologically, this resistance to infection correlated with increasing fibrovascular ingrowth into the PHDPE implants. The infected PHDPE implant had little to no ingrowth compared with PHDPE control implants. The uninfected e-PTFE implant had evidence of early fibrovascular ingrowth into the peripheral pores of the implant. CONCLUSIONS: Because of differences in pore size, PHDPE promotes faster fibrovascular ingrowth. The presence of vascularized host tissue in and around the implant lends stability and resistance to experimentally induced infection. Conservative management of clinical implant infections should be considered if bacterial seeding occurs after substantial fibrovascular ingrowth is present. Future alloplast designs should include pore sizes that will encourage invasion of the implant by host tissue.
Animals↗
Endoscopic excision of a forehead mass.
Endoscopic applications in facial plastic surgery have recently increased with the advent of new instrumentation and as surgeons have become more accustomed to their use. We report the first case (to our knowledge) of an endoscopic removal of a forehead soft tissue mass. The endoscopic approach allows the surgeon access to the forehead area with placement of a skin incision in the hair-bearing scalp. This type of approach is especially of value in patients with a predisposition to unusual scar formation or in those with smooth skin in which a direct incision would yield a noticeable scar.
Adult↗
Characterization of a rabbit model of staphylococcal osteomyelitis.
We previously described a rabbit osteomyelitis model that involved the direct introduction of Staphylococcus aureus into devascularized bone. To further evaluate the model, we performed experiments aimed at correlating the microbiological, radiographic, and histologic parameters involved in the development of experimental osteomyelitis. Using the strain UAMS-1, we achieved an infection rate of 75% with an inoculum as small as 2 x 10(3) colony-forming units. However, development of significant radiographic and histologic signs of disease required an inoculum of at least 2 x 10(4) colony-forming units. Radiographic signs were minimal 1 week after infection and progressed steadily to a maximum 3 weeks after infection. In contrast, histologic signs of disease were observed within 1 week and remained essentially unchanged throughout the 4-week evaluation period. Unlike the results obtained with UAMS-1, rabbits infected with the heavily encapsulated Staphylococcus aureus strain Smith diffuse exhibited little evidence of disease even when infected with 2 x 10(6) colony-forming units. The reduced virulence of strain Smith diffuse was surprising given its greatly enhanced virulence (relative to UAMS-1) in a murine peritonitis model of staphylococcal disease. These results suggest that UAMS-1 expresses virulence factors that are important in the pathogenesis of osteomyelitis and that some or all of these virulence factors are either absent or are not expressed in strain Smith diffuse. Most importantly, the results suggest that our model may be appropriate for the identification and characterization of these virulence factors.
Animals↗
Planning significant and meaningful research in exercise science: estimating sample size.
Exercise science researchers are familiar with the use of parametric tests to detect significant differences among treatment groups. However, in planning research a question asked with increasing frequency is, "How many participants are needed to detect real and meaningful differences among groups?" In this paper, we provide an overview of the use of alpha, power, and effect size in planning sample sizes that allow tests of real and meaningful differences among groups. Because effect size is the parameter most often missing, we have located meta-analyses in sport and exercise psychology (n = 26), and motor behavior (n = 6). We provide examples and a discussion of how researchers can use these effect sizes along with common estimates of alpha and power to plan for the sample size needed to detect real and meaningful group differences.
Exercise↗
"Kids caught in the middle".
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Adolescent↗
When the past becomes the present.
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Forecasting↗
Cold relief.
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Administration, Intranasal↗
Happy holidays means kids in the back seat, with their belts fastened.
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Accidents, Traffic↗
Intracellular receptors use a common mechanism to interpret signaling information at response elements.
The glucocorticoid receptor (GR) activates transcription in certain glucocorticoid response element (GRE) contexts, and represses or displays no activity in others. We isolated point mutations in one GRE, plfG, at which GR activated transcription under conditions in which the wild-type element was inactive or conferred repression, implying that GREs may carry signals that are interpreted by bound receptors. Consistent with this notion, we identified a mutant rat GR, K461A, which activated transcription in all GRE contexts tested, implying that this residue is important in interpretation of GRE signals. In a yeast screen of 60,000 GR mutants for strong activation from plfG, all 13 mutants isolated contained substitutions at K461. This lysine residue is highly conserved in the zinc-binding region (ZBR) of the intracellular receptor (IR) superfamily; when it was mutated in MR and RARbeta, the resulting receptors similarly activated transcription at response elements that their wild-type counterparts repressed or were inactive. We suggest that IR response elements serve in part as signaling components, and that a critical lysine residue serves as an allosteric "lock" that restricts IRs to inactive or repressing configurations except in response element contexts that signal their conversion to transcriptional activators. Therefore, mutation of this residue produces altered receptors that activate in many or all response element contexts.
Animals↗
A novel organ preservation protocol for advanced carcinoma of the larynx and pharynx.
OBJECTIVE: To pilot a targeted chemoradiation protocol for patients with advanced carcinoma of the larynx and pharynx that would circumvent upper aerodigestive tract dysfunction related to major oncologic surgery. DESIGN: Weekly intra-arterial infusions of supradose cisplatin (150 mg/m2 per week x 4) rapidly delivered to the tumor bulk, simultaneous intravenous sodium thiosulfate for systemic drug neutralization, and conventional external-beam irradiation (1.80-2.00 Gy per fraction x 35) were used. Between February 1991 and April 1994, 42 patients were treated who would otherwise have required a major resection of the tongue base, pharyngeal wall, or larynx. MAIN OUTCOME MEASURES: Tumor response, toxic effects, disease control above the clavicle, preservation of the larynx, maintenance of oral nutrition, and overall and disease-related 2-year survival. RESULTS: Three complications were related to the weekly transfemoral superselective intra-arterial procedures performed 160 times. Grade 3 to 4 chemotoxic effects were infrequent, occurring in 9 (5.5%) of 160 cycles, and only 1 patient required a radiotherapy break because of severe mucositis. A complete response in the primary site was obtained in 36 (86%) of 42 patients, 2 of whom had residual disease in the neck. Median follow-up was 13 months (range, 3-46 months). To date, there have been 5 recurrences: 2 regional and 3 distant. The 2-year overall and disease-related survival was 64% and 76%, respectively. The rate of disease control above the clavicle at 2 years was 86%. CONCLUSIONS: We believe this chemoradiation protocol represents an effective management scheme for patients with advanced head and neck cancer while minimizing dysfunction and possibly improving survival.
Adolescent↗
Effects of intraoperative tissue expansion and skin flaps on wound closing tensions.
OBJECTIVE: To evaluate the effect on wound closing tension of acute tissue expansion combined with development of a rectangular flap compared with simple undermining with rectangular flap development. DESIGN: Wound closing tensions of 30 acutely expanded skin sites and 30 matched undermined sites were compared after development of rectangular flaps. Analysis of covariance was used to determine statistical significance. SUBJECTS: Ten domestic piglets. RESULTS: When mean values of wound closing tension for the expanded rectangular flap were compared with those of the undermined rectangular flap a significant difference was found at the intermediate points along the curve for tension vs length of skin stretch. CONCLUSION: For small lesions, acute tissue expansion in conjunction with the use of a rectangular flap results in decreased wound closing tensions when compared with simple undermining with the use of a flap.
Animals↗