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Biomedical subjects

W Shaw

Publications and source records attributed to W Shaw.

At least 37 records · Page 2Linked to original sources
PubMed1993

Various methods of breast reconstruction after mastectomy: an economic comparison.

This study is an economic comparison of various methods of breast reconstruction after mastectomy. The hospital bills of 287 patients undergoing breast reconstruction at three institutions from June of 1988 to March of 1991 were analyzed. The procedures examined included mastectomy, implant and tissue-expander reconstruction, and TRAM and latissimus pedicle flaps, as well as free TRAM and free gluteal flaps. These procedures were subdivided into those which were performed at the time of mastectomy and those performed at a later admission. In addition, auxiliary procedures (i.e., revision, nipple reconstruction, tissue-expander exchange, and contralateral mastopexy/reduction) also were examined. Where appropriate, these procedures were subdivided into those performed under general or local anesthesia and by inpatient or outpatient status. Data from the three institutions were converted to N.Y.U. Medical Center costs for standardization. A table is presented that summarizes the costs of each individual procedure with all the pertinent variations. In addition, a unique and novel method of analyzing the data was developed. This paper describes a menu system whereby other data regarding morbidity, mortality, and revision rates may be superimposed. With this information, the final cost of reconstruction can be extrapolated and the various methods of reconstruction can be compared. This method can be applied to almost any complex series of multiple procedures. The most salient points elucidated by this study are as follows: The savings generated by performing immediate reconstruction varies between $5092 (p < 0.05) for free gluteal flaps and $10,616 (p < 0.05) for pedicled TRAM flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMed1992

Renal handling of enalaprilat.

Most converting enzyme inhibitors share a predominantly renal dual elimination pathway consisting of glomerular filtration and tubular secretion. Since enalaprilat has two functional acidic groups, it is likely that it may be secreted via the proximal tubule organic acid system and, thus, its clearances would exceed that of glomerular filtration rate markers. We therefore examined the renal clearance of enalaprilat in normal volunteers and compared it with simultaneously measured inulin and creatinine clearances to explore the contribution of tubular secretion to the renal elimination of the drug. Twelve healthy male subjects with an age range of 24 to 58 years (mean +/- SE, 33.1 +/- 2.8) were studied. They had representative height (178.6 +/- 1.99 cm) and weight (73.3 +/- 2.1 kg) and had normal renal function as judged by blood urea nitrogen (BUN) (6 +/- 0.3 mmol/L [17 +/- 0.8 mg/dL]), plasma creatinine (88 +/- 3 mumol/L [1.0 +/- 0.03 mg/dL]), and creatinine clearance determined by a prestudy 24-hour urine collection (123.2 +/- 6.2 mL/min). Results are as follows: mean creatinine clearance, 2.12 mL/s (127 mL/min); mean inulin clearance, 119.1 ml/min mean creatinine clearance/inulin clearance, 1.07 mean enalaprilat protein binding, 37.9% unbound enalaprilat clearance, 222.4 ml/min; and the mean fractional enalaprilat clearances were: enalaprilat clearance/creatinine clearance, 1.72 (P less than 0.05, difference from 1.0); enalaprilat clearance/inulin clearance, 1.85, (P less than 0.05, difference from 1.0). Our results demonstrate that the clearance of free enalaprilat exceeds that of inulin and creatinine, suggesting that elimination of the drug proceeds through two complementary pathways, namely glomerular filtration and tubular secretion.

Adult↗
PubMed1992

The use of diarrhoeal management counselling cards for community health volunteer training in Indonesia: the HealthCom Project.

The Indonesian Ministry of Health relies on a network of over a million kader (community health volunteers) to bring primary health care to the village level. In West Java, the Department of Health's Control of Diarrhoeal Disease (CDD) Program recently carried out an extensive research and development effort to produce effective job aids for the kader in CDD and a training programme to teach their use. A set of counselling cards was produced to provide kader with a tool to diagnose and treat diarrhoea and teach the proper use of ORS. Researchers conducted a controlled evaluation in which they measured the cards' effectiveness through observations of kader performance and interviews with mothers they had counselled. In the intervention group, 15 kader underwent two days training in the use of the cards when diagnosing and advising treatment for cases of diarrhoea in their villages. The 16 control kader received comparable CDD training without the cards. Each group provided lists of local mothers they pledged to counsel during the coming weeks. Follow-up interviews were held with these mothers to test their level of knowledge on CDD and to observe their ability to mix ORS properly. Significant performance differences between the intervention kader and mothers, and the control kader and mothers, were demonstrated. The intervention kader were consistently more accurate in their diagnoses and recommendations for treatment with a mean of 83% accuracy vs 68% for the control kader. Mothers counselled by the intervention kader also prepared ORS significantly better than the mothers counselled by the control kader, with 97 vs 74% accuracy.

Community Health Services↗
PubMed1991

The deep inferior epigastric rectus abdominis muscle and myocutaneous free tissue transfer: further applications for head and neck reconstruction.

The rectus abdominis muscle and myocutaneous free tissue transfer is a well-recognized donor site for reconstruction of complex head and neck defects. Four composite deformities were successfully managed using this donor site. The rectus abdominis myocutaneous "sandwich" flap was used for closure of a pharyngocutaneous fistula and to provide intraoral lining and external coverage for a composite mandibular defect. The rectus muscle flap was used to obliterate a compound frontal sinus injury and an orbitomaxillary defect. All flaps were based on the deep inferior epigastric vascular pedicle.

Abdominal Muscles↗
PubMed1991

The psychological benefit of orthodontic treatment. Its relevance to dental health education.

In March 1989 the third stage of a major longitudinal survey examining the psychological, social and dental effects of malocclusion and the effectiveness of orthodontic treatment was undertaken. The aim of the research was to assess the benefit of receiving dental treatment with a particular interest in orthodontic treatment. The benefits investigated were dental, psychological and social. The project has involved researchers in several professional disciplines from locations in Britain and Europe.

Child↗
PubMed1990

A clinical trial of aligning archwires.

The physical properties of a super-elastic archwire alloy (Titanol) and Nitinol were investigated by the means of a bending test. It was found that the alloy possessed super-elastic properties. A clinical trial was then carried out to compare the properties of two types of aligning archwire. Two groups of 20 patients with crowded dentitions were randomly allocated either Titanol or Nitinol, a conventional nickel-titanium alloy aligning archwire. High quality alginate impressions were taken after archwire placement in Edgewise fixed appliances and were repeated after a mean period of 35 days. The impressions were cast in dental stone and digitized using the Reflex Metrograph. The contact points of the teeth of the labial segments, together with four stable points in the rugae were recorded. This enabled the co-ordinates for the sequential study models to be superimposed upon one another, allowing tooth movement in three dimensions to be calculated. The measurement error expressed as error variance was 0.028 mm. The coefficient of reliability was 97 per cent. When tooth movement was analysed the mean movement per contact point for Titanol was 1.7 mm and for Nitinol 1.42 mm. This difference was not statistically significant (P less than 0.05, t-test). However, a clinical impression was that the super-elastic archwire proved superior to the Nitinol, because it was more readily engaged into grossly displaced teeth.

Adolescent↗
PubMed1989

An evaluation of the psychological and social effects of malocclusion: some implications for dental policy making.

Initial findings are reported from a longitudinal study investigating the effects of malocclusion on dental health and psychological well-being and the effectiveness of orthodontic treatment. Implicit in the orthodontic intervention decision process is the view that there are discernible social and psychological benefits of good occlusion. This view has not been adequately validated. The primary psychological question addressed by this study concerns the relationship between adolescents' orthodontic status and their psychological status and well-being. Empirical evidence allowed an examination of the major hypothesis that children with poor occlusion are likely to be socially and psychologically disadvantaged. Ratings of dental status and physical attractiveness, and measures of psychosocial well-being were obtained for sample of 1018, 11-12-year-old children and the associations between these variables were examined. The results provide little support for the major hypothesis that children 'suffer' psychologically from having poor dentition. Several points of caution are made with regard to this conclusion and some implications for dental policy making are considered.

Adolescent↗
PubMed1989

The effects of social class on the uptake of orthodontic treatment.

The relationship between social class and uptake of orthodontic treatment was investigated in a longitudinal cohort study of 1018 children living in South Glamorgan, Wales. Previous studies have shown that working class people make less use of dental services and receive inferior dental care than middle class people. The present investigation examined the role of one factor which appears likely to contribute to this effect: namely, the uptake of orthodontic treatment by families from different social classes. If a significant association were shown then findings relating to the effectiveness of orthodontic treatment might be confounded by this social class factor.

Adolescent↗
PubMed1986

Functional evaluation of nonsensate free flaps to the sole of the foot.

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.

Activities of Daily Living↗
PubMed1985

Lymphedema in the replanted limb of the rat: scintigraphic evaluation.

The sequence of scintigraphic patterns in resolving lymphedema in the replanted hind limb of the rat is reported. Compared to simple observation of the limb, scintigraphy using 99mTc-antimony trisulfide colloid (99mTc SbSC) provides multiple qualitative parameters for assessing lymphedema, ie, diffuse uptake in the implanted limb, focal uptake at the site of surgical repair, accumulation in the popliteal node, and activity in the liver. Quantitative analysis in this model was not helpful. Scintigraphic criteria may be utilized to study the effect of alteration in the animal model described. It is hoped that this model can be used to clarify the clinical factors influencing the resolution of lymphedema.

Animals↗
PubMed1985

Possible role of lysolecithins and nonesterified fatty acids in the pathogenesis of Reye's syndrome, sudden infant death syndrome, acute pancreatitis, and diabetic ketoacidosis.

In vitro denaturation and (or) alteration of protein function by detergents have been extensively documented. I suggest that similar biochemical and clinical features of Reye's syndrome, sudden infant death syndrome, acute pancreatitis, and diabetic ketoacidosis may be explained as sequelae of the toxic detergent effects of nonesterified fatty acids and lysolecithins. These diseases may be provoked by a drug-induced diminution of the detergent-buffering capacity of blood or tissue proteins; by excess detergents produced in vivo, consequent to lipase activity induced by viral infection or metabolic disease; or by some combination of these factors.

Acute Disease↗
PubMed1984

The medial gastrocnemius muscle flap: a local free flap.

A new application of the medial gastrocnemius muscle flap has been described. Lengthening of the sural vascular pedicle was obtained using interposition vein grafts. This allowed coverage of a larger defect than that which could have been obtained with the tethered muscle and without further insult to the already disturbed lower extremity anatomy. The principle of pedicle lengthening can be used to increase the arc of rotation of various other muscle, myocutaneous, skin, or bone flaps and thereby increase their usefulness.

Adult↗
PubMed1983

Spinal clonidine inhibits neural firing in locus coeruleus.

Intrathecally-administered clonidine inhibited the spontaneous firing of single neurons in the pontine nucleus locus coeruleus of rats. Such inhibition of neuron firing was not observed when the non-lipophilic alpha 2 adrenoceptor agonist (oxymetazoline) was administered intrathecally. It is concluded that lipophilic drugs like clonidine, when administered intrathecally, can have profound supraspinal actions and thus caution should be exercised in interpreting the sites of action of such drugs.

Animals↗
PubMed1982

Critical closing pressure, local perfusion pressure, and the failing skin flap.

A simple apparatus was devised to perfuse the rat groin flap to study the relationship between perfusion pressure and flow. Results demonstrate that a relatively high intraarterial pressure must be applied to this skin flap before blood flow will commence. Results suggest that this critical closing phenomenon is the result of surface tension, blood rheology, venous pressure, tissue pressure, and vascular smooth muscle tone. Correlating the experiments of Milton and Landis reveals that, beyond a certain distance, local perfusion pressure in a skin flap gradually decreases with increasing distance from the flap base. These observations suggest that the perfusion boundary in a skin flap forms at the point where perfusion pressure has fallen to the level of the critical closing pressure. Methods of increasing survival length of a flap by decreasing critical closing pressure are discussed. The effects of edema and pressure dressings on flap and replant survival are examined in terms of the closing pressure concept.

Animals↗
PubMed1982

Comparison of continuous and interrupted suture techniques in microvascular anastomosis.

A comparison of the continuous and the interrupted suture techniques, ten procedures each, was performed upon dogs using high frequency pulsed Doppler ultrasonography to monitor blood velocity. No statistically significant differences in the blood velocity profile were found between the two techniques. The pulsatility of the vessels after anastomosis was similar for both techniques. At follow-up examination, mean being 13 weeks, the patency rate was 100 per cent as demonstrated arteriographically for both the continuous and the interrupted techniques with statistically no significant difference in the blood velocity profile. The speed and the ease of completing a continuous anastomosis and its lack of significant hemodynamic differences compared with the interrupted technique speak well for the preferential use of the continuous suture technique.

Angiography↗
PubMed1982

Theoretical and mathematical conditions for use of linearization methods for saturation-type radioassay data.

The algebraic equivalency of nine different methods for the linearization of saturation-type radioassay data was previously demonstrated mathematically to hold under the assumption that the antibody is saturated with ligand. Although compete saturation with antibody never occurs, a good approximation to a saturation condition occurs when the product of the labeled ligand and the affinity constant is 100 or more. The mathematical basis for determining when methods for the linearization of saturation-type radioassay data are valid is derived from a development of the first-order mass action law applied to ligand-antibody reactions.

Antibody Affinity↗