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Biomedical subjects

L J Gottlieb

Publications and source records attributed to L J Gottlieb.

33 records · Page 2Linked to original sources
PubMed1990

Hyperbaric oxygen therapy.

Hyperbaric oxygen therapy involves intermittent inhalation of 100% oxygen under a pressure greater than 1 atm. Despite over a century of use in medical settings, hyperbaric oxygen remains a controversial therapy. The last 20 years have seen a clarification of the mechanism of action of hyperbaric therapy and a greater understanding of its potential benefit. However, despite the substantial evidence that hyperbaric oxygen may have a therapeutic effect in certain carefully defined disease states, many practitioners remain unaware of these findings or are concerned about using hyperbaric therapy because of the controversy it has engendered. This review examines the indications currently considered appropriate for hyperbaric oxygen and briefly evaluates animal and clinical data substantiating these indications. Areas in which the mechanism of action of hyperbaric oxygen is still not well understood, as well as possible new areas of applications, are discussed.

Carbon Monoxide Poisoning↗
PubMed1990

The radial forearm skin graft-fascial flap.

The radial forearm flap has become a versatile flap for upper extremity reconstruction. The use of the forearm flap for hand reconstruction in the patient with previously burned forearms has not been widely appreciated. In those patients whose forearms have been previously split-thickness skin-grafted on fascia, we have employed the reverse radial forearm flap as a skin graft-fascial flap for hand reconstruction and have obtained excellent functional results. Three patients at various intervals postburn are presented to demonstrate use of this flap for wrist contracture release, coverage of arthroplasties, first web space contracture release, and acute salvage of phalanges and tendons. Assessment of the hand's vascular anatomy and careful treatment of the donor area have contributed to no added morbidity and an excellent aesthetic result at the donor site.

Adolescent↗
PubMed1990

Evolving clinical and scientific concepts of upper extremity electrical trauma.

In conclusion, the pathogenesis of electrical injury is more complex than previously thought. Cellular damage occurs both by heating and electroporation. The relative contributions of heat and electroporation depend on the duration of electric current passage, the orientation of the cells, their location, and other factors. If the contact is brief, nonthermal mechanisms of cell damage may be most important. If the contact is much longer, heat damage will be most destructive. The characteristic time before heat damage predominates is probably a function of the electrical field strength in the tissue. If heat damage predominates, the injury may not be limited just to the plasma membrane but to other cell membranes as well. This is unlikely to be reversible. These parameters should also determine the pattern of injury. Damage by Joule heating is not known to be dependent on cell size, whereas larger cells are more vulnerable to membrane breakdown by electroporation. Cells do survive transient plasma membrane rupture under appropriate circumstances. Thus, if electroporation is the mechanism of damage, injured tissue may be salvageable; the challenge is to identify a technique that promptly reseals the damaged membranes. Current therapy requires a fully staffed and equipped intensive care unit, available operating suites, and the full range of available medical specialists. Major teaching hospitals are usually the prime candidates for operating an electric trauma unit. After initial resuscitation, efforts should be directed primarily toward preventing additional tissue loss mediated through a compartment syndrome. Renal and cardiac failure resulting from the release of intracellular muscle contents into the circulation must be prevented. Attention can then be directed toward maximizing tissue salvage and preventing late skeletal and neuromuscular complications. Finally, complex reconstructive procedures are needed to optimize the functional value of the remaining tissue. The eventual reconstructive goals should be kept in mind throughout the acute care of the patient.

Arm Injuries↗
PubMed1989

Skin graft survival--the bacterial answer.

An in vitro wound model was created to determine the mechanism by which bacteria cause skin graft failure. A wound surface was simulated by a human fibrin clot. Staphylococcus aureus or group A streptococcus was incubated over the clot. Either saline, human plasminogen, aprotinin, or epsilon-aminocaproic acid (EACA), or a combination of these, was added to the tubes. After 30 hours, the tubes were examined for the presence of the clot. The supernatant was then examined for the presence of fibrin degradation products (FDP). S. aureus was incapable of destroying the fibrin clot without the presence of plasminogen in the culture media. Group A streptococcus was capable of some clot degradation, but this was markedly improved in the presence of plasminogen. High FDP levels correlated with the destruction of the clot. Both aprotinin and EACA were capable of preserving the fibrin clots. In this study we carefully controlled the chemical and bacterial milieu on a simulated wound.

Antifibrinolytic Agents↗
PubMed1988

Survival after a second episode of toxic epidermal necrolysis.

Toxic epidermal necrolysis resulting from severe hypersensitivity to medication has a reported mortality of up to 66%. A patient surviving two episodes with more than a 50% skin loss is unprecedented in the medical literature. Mortality has been associated with many factors, including delayed reepithelialization, persistent skin slough, coagulopathy, severe hypoproteinemia, and sepsis. It may be possible to decrease morbidity and mortality by preventing the shearing of epidermis, thereby limiting the denuded areas. This case report describes the successful management of our patient's second episode of toxic epidermal necrolysis. The treatment of this patient in our specialized burn center consisted of careful fluid and electrolyte management, nutritional support, standard topical antimicrobials, and new modalities of local wound management.

Adult↗
PubMed1988

Fingerstick felons.

Blood drawing through the fingerstick technique is growing in popularity. Generally considered harmless, it is widely used both in hospitals and at home for monitoring blood glucose concentrations. We report 2 cases of hand infections requiring surgery that resulted from fingerstick blood glucose concentration determinations in immunosuppressed patients. This potentially serious side effect of using the fingerstick technique may be minimized by drawing the blood from the volar forearm or from other areas of the body.

Aged↗
PubMed1988

Carotid-cavernous sinus fistula complicating a complex shotgun facial injury.

Carotid-cavernous sinus fistula is a rare but major complication of severe head injuries. This pathological communication between the internal carotid artery and the surrounding cavernous sinus at the base of the skull may result in marked retinopathy, optic atrophy with permanent loss of vision, and, rarely, fatal epistaxis. Physical signs of this entity are pathognomonic and include marked chemosis, pulsating exophthalmos, and a pulse-synchronous supraorbital bruit. Diagnosis is confirmed by carotid angiography or computed tomography scan. Treatment modalities range from internal carotid ligation to catheter embolectomy and, at times, observation. A patient with carotid-cavernous sinus fistula following complex facial trauma is described. The differential diagnosis and management of this rare pathological entity is discussed. In their position as primary consultants of head and neck trauma, plastic and reconstructive surgeons should be aware of both the diagnosis and management of this unusual condition.

Adult↗
PubMed1985

The use of prophylactic antibacterials in plastic surgery: a 1980s update.

A questionnaire designed to determine the pattern of usage of prophylactic antibacterials, similar to one used a decade ago, was distributed to plastic surgeons, of whom 1718 responded. The pattern of antibacterial use in 8 major categories and 55 separate operations and circumstances was reviewed. The timing and the influence of various modifying factors was evaluated. The data present the pattern of antibacterial use by plastic surgeons at this point and time, that is, what is "usual and customary".

Anti-Bacterial Agents↗
PubMed1983

Gastrointestinal hemorrhage from pseudoaneurysms in pancreatic pseudocysts.

Gastrointestinal hemorrhage secondary to hemosuccus pancreaticus is a rare condition that poses a significant diagnostic and therapeutic challenge. It is reported to occur most commonly in the setting of acute or chronic pancreatitis with rupture of pseudoaneurysms of the spleen or hepatic artery into the pancreatic duct. In this report three such cases have been reported. Abdominal ultrasound and CT scanning can noninvasively define pancreatic pseudocysts with a high degree of accuracy. Real-time ultrasonography may document a pulsatile pseudoaneurysm. Radionuclide arterial scanning, by demonstrating pooling of blood in the area of a pseudocyst, can point to the source of bleeding in patients with pancreatitis and gastrointestinal hemorrhage. Selective celiac angiography, however, is the only diagnostic test that can definitively outline a pseudoaneurysm and demonstrate its rupture into a pseudocyst or into the pancreatic duct. Pancreatic resection including excision of the pseudoaneurysm and pseudocyst (when present) is the treatment of choice. In cases where resection is not possible, ligation of the artery proximal and distal to the pseudoaneurysm and drainage of the pseudocyst into the gastrointestinal tract is an acceptable alternative procedure. Although intraarterial catheter embolization of the bleeding vessel can be a lifesaving procedure in these very sick patients, subsequent resection of the lesion is warranted as the definitive treatment.

Adult↗
PubMedDate not supplied

Distribution of pedal burns by source and depth.

The source and depth relationships of both isolated burns to the feet and pedal burns as part of multifocal thermal trauma are evaluated. Five years of cases at the University of Chicago Burn Center were selected at random and retrospectively reviewed. There were 33 isolated burns of the foot, with a source distribution of 70% scald, 9% grease, 9% hot solid, 6% flame, and 6% other. In patients with multifocal burns that included that foot, there were 89 cases, with a source distribution of 42% scald burns, 5% grease, 2% hot solid, 39% flame, 5% electrical, 1% frostbite, and 6% other. Source versus depth and grafting needs are presented. Admission to hospital which was delayed from the date of burn showed an increased need for grafting and a longer hospitalization than those admitted on the same day. Immediate admission for compliance of proper treatment protocol is advocated. Isolated pedal burns were most commonly sustained at home, indoors, and in the kitchen. A significant number of isolated burns to the feet were from a scald source, partial thickness in depth, and required no grafting. Much of the wound management involved treating elements found in traumatic, dysvascular, and diabetic pedal lesions.

Adolescent↗
PubMedDate not supplied

Mafenide-induced pseudochondritis.

Wound infections following burns of the ear can result in the devastating complication of chondritis, requiring resection of cartilage. To prevent this, it has become common practice to dress the burned ear with mafenide acetate. We have observed six hypersensitivity reactions to the mafenide that occurred following several weeks of continuous use of the drug. The reaction mimics chondritis, causing edematous, erythematous, pruritic ears with a profuse serous exudate. There is no associated fever, systemic signs, or pain on motion of the cartilage. Treatment consists of stopping the mafenide. Recovery occurs within 72 hours. Differentiating between chondritis, with its required surgical and antibiotic treatment, and a hypersensitivity reaction is necessary to avoid further iatrogenic injury.

Adult↗
PubMedDate not supplied

Measured total energy requirements of adult patients with burns.

Adequate nutritional support is a primary concern in the treatment of patients with burns. Traditionally dietitians estimated energy requirements with the use of multifactorial equations that took into account anthropometric variables and burn severity. Recently, however, the availability of portable metabolic carts has reduced the need for dietitians to rely on predicted requirements. The use of metabolic carts, however, likely causes the underestimation of energy requirements because the carts do not always accurately measure the effects of surgery, dressing changes, and other related treatments. The aim of the current study was to determine the difference between resting energy expenditure and total daily energy expenditure. Seven adult patients whose burns ranged from 18% to 80% of their total body surface areas were studied. Total daily energy expenditure was measured with doubly labeled water, and resting energy expenditure was measured by studying respiratory gas exchange in the fed and fasted states. Total daily energy expenditure averaged 106% +/- 11% of average resting energy expenditure. Within the limits of the small data set studied, energy requirements could be measured with the use of the resting metabolic rate by allowing for an increase of 5% to 15% for nonrest activities and treatments.

Adult↗
PubMedDate not supplied

Double-rooted maxillary primary canines.

This paper includes morphological descriptions of bifurcated maxillary primary canines. Three major primary canine root types are recognized: A single root without trace of a groove, a root with a faint to distinct labial groove, a root with a broad and deep labial groove in the apical portion of the root.

Child↗