Brachial plexus surgery through the infraclavicular approach using an interscalene block.
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Adult↗
Biomedical subjects
W J Ennis
Publications and source records attributed to W J Ennis.
Strategic planning for the wound care clinic in a managed care environment.
The present trend in healthcare delivery is away from classic fee-for-service practices toward providing tightly controlled "products" in the form of Health Maintenance Organizations (HMO's). To thrive in this changing marketplace, wound clinic practitioners must understand the background of managed care and its terms, and be familiar with the concepts of capitation and incentives. Part of managed care's impact upon the specialty of wound care is that practitioners must define outcomes, healing rates and standards of care. Patient referral will depend on the cost effective delivery of care from all specialists in addition to the primary care physician. To meet these needs the authors created a hospital based wound care clinic with multiple interrelated areas of influence and have gathered statistical data. Managed care is here to stay and wound care practitioners must learn how to prepare for it and deal with it effectively.
Cost-Benefit Analysis↗
Thrombosed dialysis grafts: comparison of treatment with transluminal angioplasty and surgical revision.
PURPOSE: To compare the usefulness of transluminal angioplasty coupled with thrombectomy versus surgical revision coupled with thrombectomy in the restoration and maintenance of flow in thrombosed dialysis access grafts. MATERIALS AND METHODS: Twenty-four patients undergoing 28 angioplasty procedures were retrospectively compared to 24 patients who underwent 33 surgical revisions with a minimum 12-month follow-up period. All patients had thrombosed upper-arm expanded polytetrafluoroethylene (ePTFE) grafts. RESULTS: Initial success rates were 88% for angioplasty and 87% for surgery. Mean primary patency for angioplasty and surgery was 4.6 and 3.3 months, respectively. Mean secondary patency for angioplasty and surgery was 5.4 and 4.5 months, respectively. These differences were not statistically significant. A significantly shorter hospital stay and lower anesthesia requirement were noted in the angioplasty group. CONCLUSION: Transluminal angioplasty coupled with Fogarty thrombectomy is an effective alternative to surgical revision for thrombosed dialysis access grafts. Angioplasty extends graft life, thereby preserving proximal venous outflow sites for future use.
Angioplasty, Balloon↗
Leg ulcers: a practical approach to the leg ulcer patient.
Wound care has become a complicated science and specialty field of its own; however, all patients are initially seen by the primary care provider, and it is here that the greatest impact on wound healing and limb salvage can be made. Clinicians frequently treat chronic leg ulcers with a variety of products at various costs to the patients and third party payors based on experience not scientific literature, making the interpretation of outcomes difficult. With the problem of leg ulcers being so common, this paper sets out to review the basics of wound healing common to all wounds and to describe the current concepts of management of the three most common leg ulcers seen in a typical outpatient wound clinic setting: venous stasis ulcers, ischemic ulcers, and diabetic foot ulcers.
Humans↗
Single versus staged epidural injections of 0.75% bupivacaine: pharmacokinetic and pharmacodynamic effects.
Epidural anesthesia may be performed as a single injection or by staged doses. Thirty patients undergoing primary total hip replacement were randomly assigned to have epidural anesthesia using a single injection or a staged technique with 25 mL of 0.75% bupivacaine. Arterial plasma bupivacaine concentrations were significantly higher in the single injection group for the first 15 min but were not significantly different thereafter. Peak bupivacaine concentrations did not differ significantly between groups, but the time to achieve the peak concentration was delayed by staging injections (P = 0.001). Hemodynamic effects were similar between groups. Resolution of thoracic sensory block through T12 and duration of motor block measured by Bromage scale were both significantly longer in the staged injection group (P < 0.01). The method of epidural injection may affect resolution of neural block and the time to reach peak arterial plasma concentration of local anesthetic.
Anesthesia Recovery Period↗
Gamma spectrum analysis computations using a small computer.
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Computers↗
31P NMR spectroscopic analysis of wound healing: the effect of hydrocolloid therapy.
With the advent of managed care, wound care professionals have limited time to heal chronic wounds. They need to know whether the repair process is progressing or stagnating in response to treatments. Phosphorus-31 (31P) nuclear magnetic resonance (NMR) spectroscopic measurements of chronic wound biochemistry yields rapid knowledge of whether a wound is generating, storing, or using energy. We used 31P NMR analysis on biopsy samples to explore the energy status of two chronic non-healing leg ulcers, before and after the first week of treatment with two low-pH hydrocolloid materials. Energy generation (i.e., energy "charge") was initially low in both wounds and was significantly elevated after 1 week of treatment. Earlier work has shown that leg ulcer pathophysiology is altered during the first week of hydrocolloid treatment. This work traces the origins of such effects deeper into the cellular biochemistry and correlates the measures with the final healing outcome. 31P NMR spectroscopy may provide a real-time biochemical "fingerprint" that shows clinicians the healing status of a questionable wound. Further study is needed to confirm the reliability and validity of 31P NMR spectroscopy as a predictor of healing outcomes in other wound environments.
Adult↗