Motor vehicle engine-related burns.
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Adult↗
Biomedical subjects
R Sherman
Publications and source records attributed to R Sherman.
Treatment of chronic osteomyelitis with muscle flaps.
This article discusses a study of 36 patients with chronic osteomyelitis that had local or free muscle flaps. Reconstruction of chronic osteomyelitis requires infection control and assessment of soft tissue and bone. In patients with osteomyelitis with an ununited fracture or nonunion, stabilization of the fracture is needed.
Adult↗
External skeletal fixation and rectus abdominis free-tissue transfer in the management of severe open fractures of the tibia.
The management of severe open fractures of the tibia remains one of the more challenging problems facing the orthopedic surgeon. Patients who sustain high-energy injuries with loss of soft tissue in conjunction with displaced comminuted fractures face high rates of delayed union, nonunion, infection, and in some instances, amputation. This article discusses materials, methods, and surgical techniques.
Abdominal Muscles↗
Septopal beads and autogenous bone grafting for bone defects in patients with chronic osteomyelitis.
Thirty-five patients with chronic osteomyelitis were treated with autogenous bone grafts for bone defects. Of 35 patients, two were lost to follow-up evaluation. There were 27 men and six women. The age range was from 18 to 62 years (median age, 29 years). The bones included 22 tibias, nine femurs, and two ulnas. The size of the bone defects ranged from 2.5 x 15 cm (median defect, 2.5 x 6 cm). The length of infection ranged from two to 540 months (median, 31 months). Twenty patients had nonunions and 19 patients required soft-tissue muscle transfers. Patients were treated with systemic antibiotics and/or gentamicin (Septopal) antibiotic beads. Twelve patients were treated with Septopal beads. The range of follow-up evaluation was 24 to 68 months (median, 47 months). Thirty-one of 33 patients had one bone-graft procedure and two patients required two. The time from initial debridement and infection control to bone graft for patients not requiring soft-tissue muscle flaps was one to six weeks (median time, four weeks). For patients requiring soft-tissue muscle transfer, the range was six to nine weeks (median, six weeks). The median time to bone-graft incorporation was six months. All fractures united. Complications included two refractures from auto accidents in the immediate postoperative period, one partial muscle loss, one skin-graft loss, four pin tract draining sites, and two antibiotic-related skin rashes. There was one recurrent infection, and the infection arrest rate was 97%.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Abusive scald burns in infants and children: a prospective study.
Between July 1, 1987 and June 30, 1990, 30 consecutive deliberately scalded children were studied prospectively. Purposes of the study were to characterize the scald-abused child and address the management problems specific to this group. Mean age was 22.5 months. Many had preburn growth retardation. Mean burn size was 18.1 per cent of the total body surface area and 37 per cent required a surgical procedure for their scald. All 30 children had burns on the buttocks. Four (13.3%) had other injuries. Eighty per cent of patients had at least one complication. In 30 per cent, diarrhea complicated nutrition support, wound, or autograft care. Four (13.3%) patients with a mean burn size of 32.3 per cent of the total body surface area, diarrhea, and burns involving the buttocks, perineum, and external genitalia died of burn wound sepsis; three of these had Gram-positive bacteremia (Staphylococcus aureus and enterococcus). Burn wounds exposed to the fecal stream (buttocks) should be examined carefully and frequently for signs of infection, particularly in those patients with diarrhea.
Burns↗
Exposure of buttock burn wounds to stool in scald-abused infants and children: stool-staining of eschar and burn wound sepsis.
Between July 1, 1987 and June 30, 1990, 30 consecutive deliberately scalded children with buttock involvement were prospectively studied. Mean age was 22.5 months. Mean burn size was 18.1 per cent TBSA (total body surface area). Thirty per cent (n = 9) had diarrhea complicate their wound or autograft care. For those requiring surgery for their buttock/perineal burns, various combinations of preoperative mechanical bowel prep, oral antibiotics, postoperative occlusive intrarectal catheter, nothing-by-mouth, and rigid postoperative positioning did not protect buttock wounds and autografts from stool. Four patients had stool staining of the superficial burn wound exudate, none of whom developed burn wound sepsis or died. Four (13.3%) patients with a mean burn size of 32.3 per cent TBSA, diarrhea, and burns involving the buttock, perineum, and external genitalia died of burn wound sepsis, three of whom had deep stool staining of their burn wound and Gram-positive bacteremia. Buttock burn wounds should be examined carefully and frequently for the presence of deep stool staining, an ominous predictor of burn wound sepsis and death. Such wounds, if present, should be emergently excised.
Bacteremia↗
Insecticide injection injuries to both hands: a case report.
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Adolescent↗
Tinel's sign and Phalen's test in carpal tunnel syndrome.
Tinel's sign and Phalen's test are two provocative tests used in the diagnosis of carpal tunnel syndrome. A review of the literature reveals a wide range of sensitivity for these tests. Analyzing the historical data and comparing these to the Tinel's sign and Phalen's test results of 100 individuals without carpal tunnel syndrome (200 wrists), we conclude that the Tinel's sign is not useful in the evaluation of patients with carpal tunnel syndrome, whereas Phalen's test, which has a greater sensitivity and specificity, can be of use.
Adolescent↗
Child abuse by scalding.
Physical abuse of children by burning is a serious crime that leaves the youngest of our children with permanent physical and emotional scars. The victims tends to be less than 2 years of age. Burn-abused children usually suffer from a spectrum of physical, psychologic, and nutritional neglect. Burn abuse is costly in terms of pain, suffering and health care. Up to 15% of acutely injured children seen in emergency departments, admitted or not, have been abused. Burns were involved in up to 22% of physical abuse cases. Up to 26% of pediatric burn admissions were the result of abuse. The most common form of burn abuse in children requiring hospitalization is the scald. Physicians who treat children and burn patients should have a knowledge of the literature and clinical factors associated with pediatric burn abuse.
Burns↗
Review of treatment results for Kienbock's disease.
A review of the literature reveals that Kienbock's disease has been treated in many different ways. Excision of the lunate, with or without replacement arthroplasty, and joint-leveling procedures (radial shortening or ulnar lengthening) are the most popular procedures, but other methods of treatment (nonoperative, wrist denervation, lunate revascularization, intercarpal arthrodesis and proximal-row carpectomy) have also been performed. Based on our current understanding of the etiology, a joint-leveling procedure seems to make the most sense when surgery is indicated. However, other procedures have yielded a high success rate as well.
Carpal Bones↗
Aging alters ornithine decarboxylase and decreases polyamines in regenerating rat liver but putrescine replacement has no effect.
Aging decreases rat liver regeneration. We (1) compared the expression of ornithine decarboxylase (ODC), a critical enzyme for liver regeneration, and polyamine levels in regenerating liver of 6-week-old and 1-year-old rats and (2) evaluated the effect of exogenous putrescine supplementation on liver regeneration in 1-year-old rats. ODC messenger ribonucleic acid (mRNA) transcript sizes were the same in rats of both ages. ODC mRNA content and enzyme activity were higher in the younger rats; however, magnitudes of increase after partial hepatectomy were greater in the older rats. From peak levels, the rate of decline of the mRNA was slower in the older rats, but enzyme activity declined at the same rate in both ages. ODC apoenzyme content was significantly less in normal liver tissue from 1-year-old rats, but there was little change after partial hepatectomy in rats of either age. No change in ODC transcriptional activity was found. Hepatic putrescine levels were lower in 48 hours regenerating liver tissue from 1-year-old rats. To determine whether supplemental putrescine would increase liver regeneration in 1-year-old rats, putrescine (600 mumol/kg IP every 4 hours) was administered beginning 4 days before or at the time of partial hepatectomy. This raised polyamine levels and decreased ODC activity significantly, but there was no change in regenerating liver weight, total DNA and RNA content, and tritiated thymidine incorporation at 48 hours. These results indicate that ODC expression is different and polyamine levels are lower in 1-year-old rats than in 6-week-old rats. However, putrescine supplementation that is sufficient to decrease ODC activity has no apparent effect on regeneration.
Aging↗
Bioethics debate: poll reveals attitudes on a wide range of issues, from criminal liability for pregnant substance abusers to informing patients of a physician's HIV status.
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Age Factors↗
A biomechanical evaluation of a cannulated compressive screw for use in fractures of the scaphoid.
The compressive force generated by a 3.5 mm ASIF cannulated cancellous screw with a 5 mm head was compared with that generated by a standard 3.5 mm ASIF screw (6 mm head), a 2.7 mm ASIF screw (5 mm head), and a Herbert screw. The screws were evaluated in the laboratory with the use of a custom-designed load washer (transducer) to the maximum compressive force generated by each screw until failure, either by thread stripping or by head migration into the specimen. Testing was done on paired cadaver scaphoids. To minimize the variability that occurs with human bone, and because of the cost and difficulty of obtaining human tissue specimens, a study was also done on polyurethane foam simulated bones. The 3.5 cannulated screw generated greater compressive forces than the Herbert screw but less compression than the 2.7 mm and 3.5 mm ASIF cortical screws. The 3.5 mm cannulated screw offers more rigid internal fixation for scaphoid fractures than the Herbert screw and gives the added advantage of placement over a guide wire.
Biomechanical Phenomena↗
External fixation of extremity flaps and grafts.
Positioning extremities after soft-tissue reconstructive procedures can be difficult, particularly when flaps or skin grafts have been placed for posterior or circumferential defects. We describe a method using the patient's existing external fixator, when present, to aid in the postoperative care and positioning of the patient.
Adult↗
Aging is associated with reduced liver regeneration and diminished thymidine kinase mRNA content and enzyme activity in the rat.
We studied the effect of aging on rat liver regeneration. We compared the time course of total hepatic mass, DNA and RNA accumulation, and thymidine kinase (TK) messenger RNA (mRNA) content and enzyme activity, after two-thirds partial hepatectomy in 6-week-old (young adult) and 1-year-old rats. Whereas 6-week-old rats had completely regenerated all liver mass, DNA, and RNA by 7 days, the regenerating 1-year-old rat livers at 7 days contained only 60% to 70% of the mass, DNA, and RNA in the normal 1-year-old rat liver. However, rates of tissue regeneration during this time were very similar in both ages. At 28 days the weight and RNA content of the 1-year-old rat livers were 93% of normal, but total DNA was still reduced, at 78% of normal. In the younger rats TK mRNA content and enzyme activity increased substantially after partial hepatectomy and were observed to peak at 24 hours. In the 1-year-old rats TK mRNA was less abundant in normal liver and the peak level observed was lower and delayed until 48 hours. Nonetheless, the incremental increase from baseline to peak was greater in the 1-year-old than in the 6-week-old rats. In contrast to the mRNA, TK activity peaked at 24 hours, but at substantially lower levels than in the 6-week-old rats. Rates of disappearance of TK mRNA and enzyme activity after peak levels were not significantly different by age.(ABSTRACT TRUNCATED AT 250 WORDS)
Aging↗
Chronic fatigue syndrome in Minnesota.
Chronic fatigue syndrome (CFS), an illness characterized by debilitating fatigue and a number of associated symptoms, was identified in 135 patients using the case definition provided in 1988. The demographic features of these patients, 97% of whom resided in Minnesota, were similar to those reported elsewhere. About three-fourths of the cases occurred between 1984 and 1989, and in 123 (91.1%), the illness began with what appeared to be an acute infection. Patients had been ill for an average of 4.3 years before enrollment in the study. Fatigue was their most troublesome symptom, although a majority of the patients rated most of the general symptoms and neuropsychological complaints associated with CFS as moderate or severe. Follow-up data obtained on 62 patients one year after initial evaluation revealed that none had completely recovered. However, about 40% reported some improvement in each of the CFS symptoms.
Adult↗
Spontaneous pneumoperitoneum. A surgical dilemma.
Pneumoperitoneum is usually the result of hollow viscus perforation with associated peritonitis. Nonsurgical spontaneous pneumoperitoneum incidental to intrathoracic, intra-abdominal, gynecologic, iatrogenic, and other miscellaneous causes not associated with perforated viscus have been documented in the literature. Seven cases of spontaneous pneumoperitoneum admitted over 3-year period to Grady Memorial Hospital, Atlanta, Georgia are reported. Six patients with pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in any of these patients. A seventh patient, on ventilatory support, was managed conservatively after performing a diagnostic peritoneal lavage that was negative. There were no cases of radiographically misdiagnosed pneumoperitoneum. Pneumoperitoneum, preceded by a reasonable incidental cause in a patient with a adequate abdominal examination, may warrant continued observation thus avoiding an unnecessary laparotomy.
Adult↗