Reston: an alternate method of skin graft fixation.
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Bandages↗
Biomedical subjects
R Saltz
Publications and source records attributed to R Saltz.
Combining methods to identify new measures of women's drinking problems. Part I: The ethnographic stage.
In recent years, some researchers in the alcohol survey field have raised concerns about the shortcomings in severity/frequency scales for drinking and drinking problems used for both clinical and household survey purposes, especially with regard to women. This article reports on Part I of a two-part study that used ethnographic and survey methods to assess indicators of drinking problems among women across various US subcultures. Methodology for the ethnographic component consisted of three steps: analysis of findings in literature on indicators of women's drinking problems, and analysis of indicators addressed in the most commonly used standard instruments for alcohol assessment; semi-structured interviews with 12 specialists in treatment and/or research who focused on alcohol problems of women; and semi-structured interviews with 65 women from four ethnic populations who were clients in alcohol treatment centers. Analysis of these data from the ethnographic component produced a taxonomy of indicators of women's drinking problems and fourteen novel indicators that are not included or are inadequately examined in the most commonly used alcohol assessment instruments. The novel indicators were then incorporated into a questionnaire used for a county-wide survey of men and women that assessed indicators of drinking problems. Report of findings from the survey are presented in the second paper of this series.
Adolescent↗
The bubble cast: to monitor and protect flaps.
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Casts, Surgical↗
Abdominal wall reconstruction after temporary abdominal wall closure in trauma patients.
We retrospectively analyzed 36 patients requiring temporary abdominal wall closure on admission to a level I trauma center from 1988 to 1992. There were 10 deaths (28%) in the study population. Of the 26 survivors, 8 patients (31%) had primary fascial closure at initial hospitalization, whereas 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of these 18 patients, 13 have had ventral herniorrhaphy at subsequent admission. Eight of these patients had primary fascial closure, 4 required primary fascial approximation with prosthetic onlay reinforcement, and 1 required multiple operations including prosthetic reconstruction and eventual complex tissue transfer. Complications occurred in 3 patients (14%) and included two wound seromas, which were drained nonoperatively, and a wound infection necessitating removal of prosthetic material and subsequent reconstruction with complex tissue transfer. Follow-up reveals no recurrent hernia at 24 months. Abdominal wall reconstruction after temporary closure can be done safely and promptly, with good functional and esthetic results.
Abdominal Injuries↗
Fibrin sealant.
Fibrin sealant consists of fibrinogen and thrombin solutions, which generate a crosslinked fibrin clot in a process that mimics the last stage of the physiologic coagulation system. Fibrin sealants have been used widely in Europe in the past two decades for hemostasis, sealing, and as a vehicle for drugs and growth factors, and as a biologic glue. This review discusses the various types of fibrin sealants (autologous, homologous, commercial), their composition, mechanism of action, functional characteristics, experimental and clinical uses, limitations, complications, adverse reactions, and viral safety.
Animals↗
Combining methods to identify new measures of women's drinking problems. Part II: The survey stage.
This is the second of a two-part report on a study aimed at investigating novel indicators of drinking problems among women drinkers. The study was motivated by the suspicion that most measures of drinking problems grew out of studies of male populations with the likelihood that such measures would be less relevant for female drinkers. The first part of this report describes the background for the study and the steps that were taken to generate a short list of "novel" indicators which were then incorporated into an instrument for a general population survey. Using several measures of alcohol consumption as criteria for evaluating the indicators, this paper reports on which indicators may uncover dimensions of alcohol problems not already subsumed by a standard population screen, the CAGE. In particular, results suggest that indicators of "high capacity for alcohol", "seeking out a 'wet' environment", and "planning opportunities to drink" are promising for both women and men, with more qualified support for less "frequent illness" (for women) and "excessive behavior" (for men). These results must be viewed within the context of an exploratory study and indicate avenues for further research.
Alcoholism↗
Endoscopic harvest of the omental and jejunal free flaps.
Experimental and clinical cases document that the omentum and jejunum can be harvested successfully as a free flap using laparoscopic assistance. Our gross and microscopic findings attest to the viability of this approach. If the omentum is not needed in it entirety, one can safely custom design the free flap to match the defect size, leaving only a small abdominal scar, as illustrated in the partial omentectomy case. The long, large vessels can simplify the microanastomosis in difficult situations and avoid the use of vein grafts. The abdominal incision required in most of our cases was minimal, with an inconspicuous donor site scar. The procedure has been well tolerated by the patients, and the postoperative course has been unremarkable. Although some modifications already have been presented to the original technique of laparoscopic jejunal and omental harvesting, more cases are necessary before one can reach definitive conclusions about whether the endoscopic approach is significantly better than the classical open technique.
Burns↗
Laparoscopically harvested omental free flap to cover a large soft tissue defect.
OBJECTIVE: The omentum has been a very important tool in the armamentarium of the reconstructive surgeon. It has lost much of its value because of the morbidity associated with laparotomy. Laparoscopic surgery has become a popular technique and allows operations to be performed with minimal morbidity. The possibility of harvesting the omental free flap with the laparoscope and its use in reconstructive surgery has been demonstrated. SUMMARY BACKGROUND DATA: Since the first laparoscopic cholecystectomy was performed, many surgeons have learned the procedure. Other surgical specialties have also benefited from this technique. The omentum provides a large amount of vascularized tissue and excellent wound coverage. It can be transferred as a pedicle flap, or as a free flap, using microvascular technique. METHODS: The procedure was developed and refined in an animal model. One team harvested the omentum with laparoscopic assistance, while the other team prepared the recipient vessels. After completion of the microvascular transfer, the dogs were observed for 14 days. At that time, the omental tissue was examined for gross and histologic changes. A clinical case is also presented. RESULTS: Gross and microscopic studies documented the viability of this approach. The patient tolerated the procedure well and had an unremarkable postoperative course. CONCLUSIONS: Experimental and clinical evidence shows that the omentum can be successfully harvested as a free flap using laparoscopic assistance. This technique may prove to be of clinical significance and very useful for reconstructive surgery with less morbidity.
Animals↗
Alcoholic beverage server liability and the reduction of alcohol-involved problems.
Legal liability of alcoholic beverage servers has been suggested as a means to stimulate preventive serving practices and thus reduce alcohol-involved problems. A number of variables contribute (both negatively and positively) to the potential of such liability and a conceptual model that links these variables was developed. In this project, an expert legal panel was used to identify and rate the major legal factors contributing to server liability. As a result each state was ranked according to its relative level of liability exposure. States that ranked highest in server liability were found to have more publicity about such liability, greater awareness and higher concern among licensed establishment owners/managers and different serving practices compared to states with lowest liability exposure. As a result we conclude that server liability has a real potential for reducing alcohol-involved problems but additional research is needed.
Accidents, Traffic↗
A method to determine shear adhesive strength of fibrin sealants.
The adhesive strength of fibrin sealants has not been rigorously evaluated to date. The adhesive strength of six different concentrations of cryoprecipitated fibrinogen as well as the commercially available fibrin tissue adhesive Tissucol was tested under controlled conditions utilizing split-thickness skin grafts as the test adherand. This test configuration permitted the modeling of bonding strength for attachment of skin grafts as well as incorporate established engineering test standards for adhesives. An increase in fibrin concentration corresponded with an increase in shear adhesive strength. No significant increases in adhesive strength were attained after 5 min of bonding for all tested concentrations, except for the commercial adhesive, which attained the adhesive strength of an equivalent concentration of cryoprecipitated adhesive after 90 min. The adhesive strength, however, was an order of magnitude less than reported values of the tensile strength of fibrin material for similar concentrations. Therefore, it is important that the surgeon use a sufficiently high fibrinogen concentration for the specific clinical indication. The method of fibrin sealant preparation and/or the compounding adjuncts appear to have an effect on the development of adhesive strength.
Adhesiveness↗
Mechanical properties of fibrin adhesives for blood vessel anastomosis.
Various methods have been used for anastomosing, or attaching, two ends of a severed blood vessel together. The most common method, suturing, is tedious, can be time-consuming, and requires special training in microvascular surgery. Other methods, such as mechanical devices and lasers, have some problems as well. The use of fibrin adhesives for blood vessel anastomosis might eliminate some of the current problems by allowing a quicker, simpler, and more reliable method of attachment. Although mechanical studies have been conducted to determine fibrin glue properties in shear, tensile, and burst tests; most of these studies have used skin or intestinal tissue. Therefore, to evaluate the feasibility of using fibrin glue as an adhesive for blood vessel anastomosis, the mechanical properties of blood vessels joined with fibrin glue were examined using tensile and burst tests. High and low fibrinogen concentrations were tested after 5- or 45-min time periods. In addition, three clinical methods of attachment were compared: end-to-end anastomosis, vessel overlapping, and suturing. In this study, because the adhesive strength was not found to increase significantly after 5 min, setting times for fibrin glue may be short enough to make it a clinical option when compared to suturing. In addition, the higher fibrinogen concentration did not result in a significantly higher adhesive strength, indicating that the lower concentration fibrin adhesives may be of comparable strength to the higher concentrations for clinical applications.
Anastomosis, Surgical↗
Muscle and musculocutaneous flaps of the foot.
This article describes the most common options available for reconstruction of the foot. The foot is considered a group of different regions, and it is helpful to classify it into four different anatomic and functional areas. The planning and final outcome of the reconstruction are based on the type of flap available for a specific defect in one of these four territories.
Foot↗
Experimental and clinical applications of fibrin glue.
A 2-year experience with laboratory and clinical applications of fibrin glue is presented. An autologous technique, which eliminates the danger of multidonor preparations, has been developed in our blood bank. While one can obtain different fibrinogen concentrations from the same amount of a patient's blood, in vitro mechanical testing demonstrated that at higher fibrinogen concentrations there is an increase in shear adhesive strength. Evaluation of skin-graft take in 16 Sprague-Dawley rats did not demonstrate significant differences in healing when adhesive use was compared with suture technique. In a clinical study, four different groups of patients (facial burns, hand burns, difficult graft sites, and miscellaneous surgical applications) benefited from autologous or single-donor fibrin glue for a total of 82 cases. There are several distinct advantages to the use of fibrin adhesive: The autologous technique eliminates the risk of transmissible viral diseases (AIDS, hepatitis); it can be used as a sealant in the treatment of seromas, dural leaks, and lymphoceles; and it improves hemostasis and early graft adherence. Face and hands are resurfaced with sheet grafts in a single procedure, obtaining a better aesthetic result with complete graft take and immediate start of physical therapy. Neither sutures nor pressure dressings are required. The minimal postoperative care associated with early return to normal activities seems to increase the satisfaction of patients and nurse personnel.
Adolescent↗
Sapphire ring constriction syndrome.
An uncommon case of a partially embedded ring under the skin is presented. A technique for removal is described. All previously reported cases as well as ours occurred in mentally handicapped individuals.
Adult↗
Diagnostic peritoneal lavage for blunt abdominal trauma: an unusual result.
We have reported the unusual finding of a grossly bile-stained peritoneal lavage 24 hours after blunt abdominal trauma, associated with neither enteric, hepatic, nor biliary tract injury at laparotomy. Intraoperative transcholecystic cholangiography is recommended in such a situation to rule out biliary tract injury.
Abdominal Injuries↗
The role of splenorrhaphy in splenic trauma.
Eighty-five cases of splenic trauma that were treated surgically from 1981 to 1983 were reviewed to define the exact role of splenorrhaphy. There were 73 male and 12 female patients with a mean age of 34 years. The mechanism of injury was blunt trauma in 51 and penetrating trauma in 34. The incidence of associated intraabdominal injury was 31 per cent and 79 per cent in blunt and penetrating trauma, respectively. Splenectomy was performed in 43 (51%) and splenorrhaphy in 42 (49%). Splenorrhaphy was performed in 19 (37%) who had blunt trauma and 23 (67%) who had penetrating trauma (P less than 0.01). Overall six patients died, three in the splenorrhaphy group (7.1%). Only one patient who had splenorrhaphy required reoperation for splenic hemorrhage. The authors conclude that about 50 per cent of all injured spleens in the patient population studied can be salvaged during laparotomy for splenic trauma, the splenic salvage rate is higher in penetrating trauma, and splenorrhaphy is a safe operation.
Adolescent↗
A seven-year follow-up of intelligence test scores of foster grandparents.
After 7 years, a group of originally nonemployed poverty-level older people (over 60) who had been employed as foster grandparents were retested with the WAIS. Four WAIS subtests - Vocabulary Similarities, Digit Span, and Block Design - were employed. Of the original group of 39, complete data were available for 28; 18 of these were still working on the project, and the other 10 had dropped out. Dropouts as a group tested lower originally and also showed more deterioration in functional health ratings over time. For the total group of 32 foster grandparents, three subtest scores showed stability over the 7 years. Only Digit Span showed a statistically significant drop. Neither age nor the initial level of health or WAIS scores was related to test-score changes over time.
Aged↗