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PubMed2000

Context and methodological decontextualization in nursing research with examples from phenomenography.

In both human science and nursing research the concept of context is important. However, context can be understood in different ways. The aim of this article is to elucidate, discuss and problematize context, decontextualization and recontextualization in some health care-related phenomenographical studies. A further aim is to problematize the concept of context in a wider perspective of human science, in order to gain a better understanding of phenomenographical research related to nursing care. Our analysis indicates that the complex phenomena which characterize nursing research demand a broad contextual understanding. Both the local or immediate context and the global or mediated context must be considered, as they are dialectically related. This includes the informants' experiences of the phenomenon of interest as well as the socio-cultural discourse. A balance between openness and pliability to the phenomenon is suggested. Reflection is considered an important tool in this process. Within phenomenography, the interest is directed towards conceptions of certain aspects of the world. Thus, context in a wider sense is given a subordinate role. Accordingly, phenomenography is considered to have limited applicability in nursing research when complex phenomena are to be studied.

Clinical Nursing Research↗
PubMed1996

A randomized controlled trial of hydrocolloid dressing in the treatment of hypertrophic scars and keloids.

BACKGROUND: Silicone gel sheeting has been investigated for use in the treatments of keloids and hypertrophic scars. Its mechanism of action may be related to scar hydration. OBJECTIVE: The purpose of the present study was to evaluate a hydrocolloid occlusive dressing that also acts by promoting a moist environment. METHODS: In a randomized controlled prospective study, patients were allocated to receive hydrocolloid dressing or moisturizer to keloids or hypertrophic scars. Scar size and volume, color, patient symptoms, and transcutaneous oxygen measurements were taken. RESULTS: There was significantly reduced itching (P < 0.03), somewhat reduced pain (P < 0.08) and increased pliability (10%) for both treatments over 2 months. CONCLUSION: Hydration of the scar for 2 months resulted in symptomatic improvement, but no change in physical parameters.

Adult↗
PubMed2005

Comparison of two absorbable monofilament polydioxanone threads in intradermal buried sutures.

BACKGROUND AND OBJECTIVES: Two absorbable polydioxanone threads are compared regarding intraoperative handling qualities, scar dehiscence, and possible side effects. METHODS: In 30 excisions, half of each suture was performed with PDS II (Ethicon GmbH, Norderstedt, Germany), whereas the other half was closed with Serasynth (Serag-Wiessner, Naila, Germany). Clinical evaluation for scar spreading, spitting of the sutures, hypertrophic scarring, or suture granuloma was performed 3 and 6 months after surgery. RESULTS: No significant difference in scar spreading, hypertrophic scarring, or the incidence of suture granuloma was noted. A significantly lower frequency of spitting was seen with Serasynth than with PDS. The handling and suturing properties of SerasynthM were estimated to be slightly superior compared with those of PDS. CONCLUSION: Our study shows that PDS and Serasynth provide equal cosmetic results when applied in an appropriate suturing technique. Possibly owing to its better pliability, the frequency of spitting was lower with Serasynth.

Absorbable Implants↗
PubMed2005

The Kerf-Cut dressing: application of a woodworking technique for efficient postsurgical wound care.

BACKGROUND: Simple surgical excision is one of the most common treatment methods in the dermatologist's armamentarium. We describe a precise postsurgical dressing technique that can be used for wound care of those patients whose treatment involves removal of lesions via cutaneous surgery. OBJECTIVE: To devise a novel, precise, and effective dressing technique for postsurgical wound care. MATERIALS AND METHODS: We describe the technique using common in-office instruments. RESULTS AND CONCLUSION: Wound dressings for lesions located on curved areas such as the ears, nose, cheeks, and chin often exhibit less than adequate adherence and stability. The kerf-cut dressing technique optimizes pliability of dressing tape, and this maximizes efficient and stable application of postsurgical wound dressings to curved areas of the body.

Bandages↗
PubMed2006

New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars.

BACKGROUND: Keloids and hypertrophic scars are benign growths of dermal collagen that usually cause major physical, psychological, and cosmetic problems. METHODS: In this 12-week single-blinded clinical trial, 69 patients were randomly assigned into three study groups. In Group 1, intralesional triamcinolone acetonide (TAC, 10 mg/mL) was injected at weekly intervals for a total of 8 weeks. In Group 2 [TAC+5-fluorouracil (5-FU)], 0.1 mL of 40 mg/mL TAC was added to 0.9 mL of 5-FU (50 mg/mL). This combination was injected weekly for 8 weeks. In Group 3, in addition to weekly TAC+5-FU injection for 8 weeks, lesions were irradiated by 585-nm flashlamp-pumped pulsed-dye laser (PDL, 5-7.5 J/cm2) at the 1st, 4th, and 8th weeks. Lesions were assessed for erythema, pruritus, pliability, height, length, and width. RESULTS: Sixty patients completed the study. At the 8- and 12-week follow-up visits, all groups showed an acceptable improvement in nearly all measures, but in comparison between groups, these were statistically more significant in the TAC+5-FU and TAC+5-FU+PDL groups (p<.05 for all). At the end of the study, the erythema score was significantly lower, and itch reduction was statistically higher in the TAC+5-FU+PDL group (p<.05 for both). Good to excellent improvements (>50% improvement) were reported by the patients as follows: 20% in Group 1, 55% in Group 2, and 75% in Group 3, all of which were significantly different (p<.05). Good to excellent responses were reported by the blinded observer as follows: 15% in Group 1, 40% in Group 2, and 70% in Group 3. Their differences were statistically significant (p<.05). Atrophy and telangiectasia were seen in 37% of patients in TAC group. CONCLUSION: Overall efficacy of TAC+5-FU was comparable with TAC+5-FU+PDL, but the TAC+5-FU+PDL combination was more acceptable by the patients and produced better results. Its effect on lightening of the lesion was promising. The TAC+5-FU+PDL combination seems to be the best approach for treatment of keloid and hypertrophic scars.

Adult↗
PubMed1997

Myristoyl gelatin as a sealant for Dacron vascular prostheses.

Myristoyl gelatin (MG) retains its gel structure at temperatures above body temperature without any crosslinking. As a coating material, MG adheres well to polyester fibers, and the outermost layers of the sealant that are in contact with blood or surrounding tissue become hydrophilic. We produced MG-impregnated knitted Dacron vascular prostheses (MG graft [MGG]) and investigated the usefulness of MG as a sealant by replacing the thoracic aorta of dogs. MGGs (5 cm long with an inner diameter of 10 mm) were implanted in 5 mongrel dogs (10-20 kg), and the grafts were retrieved at intervals of 4 h and 2, 4, 8, and 15 weeks after grafting. There was no thrombus formation on the flow surface of the MGGs, indicating adequate antithrombogenic properties. No resorption of MG occurred until after 2 weeks, and neither immune reaction nor excessive foreign body reaction was noted. Fragmentation of the sealant induced by cell infiltration began to occur at 4 weeks, yet the sealing effect persisted. The organization of MGG was almost complete at 8 weeks. Because of its pliability and effective adhesion to polyester fibers, its antithrombogenicity, and the persistent sealing effect due to delayed biodegradation and resorption, we conclude that MG is an extremely useful sealant for polyester vascular prostheses.

Animals↗
PubMedDate not supplied

Modification of the superficial cervical axial pattern skin flap for oral reconstruction.

OBJECTIVE: To describe an extended pedicle flap based on the superficial cervical artery (SCA) for closure of oral defects in dogs. STUDY DESIGN: Anatomic study; in vivo experimental study. ANIMALS: Canine cadavers (13) and 3 dogs. METHODS: The prescapular branch of the SCA was cannulated and perfused with a lead oxide gelatin mixture. The area perfused by 1 SCA was examined as was the rostral extent of the flap. Staged implantation was performed to evaluate flap performance in vivo. In stage 1, the flap was prepared for implantation into the oral cavity. In stage 2, the flap was fully developed to include the 1 degrees, 2 degrees, and partial 3 degrees angiosome of 1 SCA pedicle. The flap was transposed by a bridging incision and a parapharyngeal tunnel into the oral cavity. The flap was used to reconstruct a partial-thickness defect created in the palate. RESULTS: The territory of the contralateral SCA was captured in all cadavers. The full flap reached the level of the canine teeth in all cadavers. In live dogs, necrosis was not observed after implantation into partial-thickness defects and dehiscence was minimal. Loss of pliability secondary to de-epithelialization and staging resulted in a limitation of rostral reach of the flap. CONCLUSIONS: Whereas the flaps did not reach as far rostrally as anticipated, they survived well in the harsh oral environment. The flap may be modified to reconstruct full-thickness palatal defects. CLINICAL RELEVANCE: The extended SCA pattern flap may be adapted for closure of oral defects.

Animals↗
PubMed1993

Creation of a systemic-to-pulmonary artery shunt by use of an internal mammary artery.

The creation of a systemic-to-pulmonary artery shunt by use of the internal mammary artery (IMA) in a 2-year-old boy with complex congenital heart defects and diminutive pulmonary arteries is described. This procedure may offer advantages over standard methods in selected patients with extremely small pulmonary arteries. The pliability, favorable anatomical position, and growth capability of the IMA reduce chances for complications, such as stenosing, kinking, and stretching of the pulmonary artery, which can cause it to become distorted, making further definitive repair difficult.

Child, Preschool↗
PubMed2000

Probing the CD lumenal loop region of the D2 protein of photosystem II in Synechocystis sp. strain PCC 6803 by combinatorial mutagenesis.

The CD lumenal loop region of the photosystem II reaction center protein D2 contains residues involved in oxygen evolution. Since detailed structural information about this region is unavailable, an M13-based combinatorial mutagenesis approach was used to investigate structure-function relationships in this vital region of D2 in Synechocystis sp. strain PCC 6803. The CD loop coding region contains close to 100 nucleotides, and for effective mutagenesis, it was subdivided into four regions of seven to eight codons. A gain-of-function selection protocol was employed such that all mutants that were selected contained a functional D2 protein. In this way, conservation patterns of residues along with numbers and types of amino acid substitutions accommodated at each position for each set of mutants would indicate which residues in the CD loop may play important structural and functional roles. Results of this study have substantiated the importance of residues previously studied by site-directed mutagenesis such as Arg180 and His189 and have identified other previously unremarkable residues in the CD loop (such as Ser166, Phe169, and Ala170) that cannot be replaced by many other residues. In addition, the pliability of the CD loop was further tested using deletion and D1-D2 substitution constructs in M13. This showed that the length of the loop was important to its function, and in two cases, D2 could accommodate homologous sequences from D1, which forms a heterodimer with D2 in photosystem II, but not the other way around. This study of the CD loop in D2 provides valuable clues regarding the structural and functional requirements of the region.

Alanine↗
PubMed1994

Differential role of long terminal repeat control elements for the regulation of basal and Tat-mediated transcription of the human immunodeficiency virus in stimulated and unstimulated primary human macrophages.

Primary human macrophages induced to differentiate through contact with autologous activated nonadherent cells were used to investigate the transcriptional mechanisms involved in reactivation of human immunodeficiency virus (HIV) replication. Through transient transfection experiments with an HIV long terminal repeat (LTR)-chloramphenicol acetyltransferase reporter construct, we show that macrophage differentiation results in a 20-fold upregulation of basal LTR activity. To identify sequence elements responsive to the differentiation process, point mutations introduced into the LTR were tested in differentiated and undifferentiated macrophages. Several elements were identified as positive regulators of basal transcription. TATA, Sp1, and NF-kappa B binding sites were the most influential. The low-affinity site for LBP-1 (UBP-1) functioned as a negative regulator of LTR activity in undifferentiated macrophages, but this influence was lost upon differentiation. When tat was cotransfected into the expression system, the requirement for LTR elements identified as important for positive regulation of basal transcription remained in undifferentiated macrophages. Interestingly, however, the mutations in positive control elements which debilitated activity in undifferentiated macrophages had no effect on LTR activity in differentiated macrophages. Thus, it appears that while HIV-LTR activity is highly dependent on cellular transcription factors in undifferentiated cells, in differentiated macrophages the viral protein Tat confers pliability on the LTR and facilitates autonomy from absolute cellular control mechanisms. In vivo, release from either positive or negative regulation via cellular proteins may facilitate reactivation of HIV in macrophages.

Adult↗
PubMed1990

Expandable tubular stents for treatment of arterial occlusive diseases: experimental and clinical results. Work in progress.

The balloon-expandable vascular prosthesis consists of a flexible, knitted tantalum wire mesh tube. To demonstrate its pliability, this prosthesis was tested experimentally in 10 mongrel dogs by implanting it into the proximal femoral arteries. The maximum follow-up time was 1 year. On the basis of the experimental results, in which there was no relevant stenosis, occlusion, or migration of the vascular prosthesis, nine patients were treated: one with iliac artery occlusive disease and eight with superficial femoral artery (SFA) occlusive disease (four reocclusions after angioplasty and four unsatisfactory primary angioplasty results). One SFA lesion was treated with the crossover method from the contralateral side. All implants remained patent without hemodynamically significant stenoses, with the longest observation time being 6 months. Flexible, expandable vascular prostheses are promising adjuncts to angioplasty.

Aged↗
PubMed2003

Motion - computerized tomographic colography is a better method for screening for polyps: arguments against the motion.

Computerized tomographic (CT) colography is an exciting technique whereby images of the colonic wall and lumen can be obtained without colonoscopy. It is not as good as conventional colonoscopy, however, because of both inherent and performance limitations. Among the former is the inability to visualize subtle mucosal lesions, such as alterations in colour or pliability. More importantly, CT colography is strictly a diagnostic technique, and does not allow biopsy or removal of polyps. The vigorous bowel preparation required for this procedure can be very unpleasant for the patient, and includes purgatives followed by distension of the colon with air. Unlike with colonoscopy, adherent stool can be difficult to distinguish radiologically from polyps or cancers; as a result, many patients require colonoscopy anyway. The major performance limitations of CT colography are poor sensitivity and specificity compared with conventional colonoscopy. Rectal lesions, flat adenomas and diminutive adenomas are especially difficult to detect, and false-positive results are also common. In addition, the procedure is expensive and less cost effective than colonoscopy. CT colography takes relatively little patient time, but a substantial amount of time is needed for the radiologist to interpret the images. Interobserver variability is high. For all of these reasons, CT colography cannot be recommended as a screening test for colorectal neoplasia.

Colonic Polyps↗
PubMedDate not supplied

Studies on constituents of moisturizers: water-binding properties of urea and NaCl in aqueous solutions.

A water content of about 10% in the horny layer is necessary for softness and pliability of this part of the epidermis. In conditions with dry skin, emollients of different types are used. It is important that solid data are collected about the effect of the ingredients of emollients and moisturizers. Urea has since long been used in the treatment of dry skin. In the present report, the mixture of urea and sodium chloride has been analyzed with respect to its effect on the water vapor pressure in concentrated solutions. The depression of the water vapor pressure by NaCl and urea was found to be additive. Thus, the decrease in water vapor pressure in aqueous solution of urea-NaCl mixtures can be estimated by adding the decrease of water vapor pressure caused by dissolving the pure compounds. The results indicate that urea and NaCl in aqueous solution do not interact strongly and are, therefore, compatible in moisturizing preparations. They can, therefore, both be expected to be effective in mixtures giving a better than one of them alone.

Dermatologic Agents↗
PubMedDate not supplied

Effects of free radicals on coronary artery.

Coronary arteries supply blood to the heart and hence the control of coronary tone is pivotal to human survival. Reactive oxygen species (ROS) in specified amounts play an important role in normal metabolic and signalling processes. However, excess ROS can cause severe cardiovascular damage. For example, NO is produced by endothelium as a signal for relaxation. However, in an inflammatory response, NO from endothelium or macrophages can combine with superoxide to produce more deleterious peroxynitrite. Excess ROS have been associated with loss of coronary artery pliability--loss of contraction in some instances and relaxation in others. Atherosclerosis may also be considered an inflammatory response that leads to artery blockage, coronary disease and ischaemia-reperfusion. ROS produce various types of damage to ion channels and pumps and this damage is associated with vascular diseases such as atherosclerosis and hypertension. Endothelium and smooth muscle in the coronary artery are also affected differently by individual ROS. In fact, endothelium may act to protect the underlying smooth muscle against ROS. This review will give an overview of this field.

Cardiovascular Diseases↗
PubMed2000

Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair.

BACKGROUND: Mitral valve repair is the procedure of choice to correct mitral regurgitation (MR). Although chordal replacement with expanded polytetrafluoroethylene (ePTFE) has been widely accepted to repair anterior mitral prolapse and other difficult situations, the long-term results of the repair and the fate of ePTFE have not been delineated. METHODS AND RESULTS: From July 1988 to April 1999, 74 patients (49 males, 25 females) aged 17 to 77 years (mean age 55. 3+/-14.8 years) underwent mitral valve repair with chordal replacement with ePTFE. The follow-up period was from 6 months to 11. 3 years (mean 4.6+/-3.2 years). The causes of MR were degenerative in 65 patients (88%) and infective in 9 (12%). Three patients had active infective endocarditis. Valve lesions were anterior in 35 patients, posterior in 10, and both anterior and posterior in 29. Various procedures for plasty of leaflets were necessary in 37 patients (50%). Atrial fibrillation was associated in 38 patients (51%), and the maze procedure has been performed in a selected group of 30 patients (41%) since July 1992. There was 1 in-hospital death (1.4%) and 3 late cardiac deaths (4.1%). More than moderate MR developed in 12 patients (17%) during the follow-up period. Three of these patients required early reoperation within 1 year due to hemolysis. Two patients underwent mitral valve replacement at 6 and 8 years after repair, respectively. The actuarial reoperation-free rates at 5 and 10 years were 94.3+/-2.8% and 81.7+/-9.1%, respectively. Sinus rhythm was restored in 21 patients (70%) with the maze procedure. There was only 1 thromboembolic episode (0. 3%/patient-y) in a patient with atrial fibrillation who did not undergo the maze procedure. Event-free survival rates as assessed by the freedom from cardiac death, thromboembolism, reoperation, and anticoagulation-related hemorrhage at 5 and 10 years were 91.3+/-3. 4% and 71.6+/-9.7%, respectively. There was no relationship between recurrent MR and the change of ePTFE. Structural analysis of the ePTFE resected during reoperation revealed no calcification and showed remaining flexibility and pliability. Protein infiltration was observed in the ePTFE, and collagenous proliferation was recognized at the site of fixation to the valve leaflet and the papillary muscle. The surface of the ePTFE was completely endothelialized, which may induce antithrombogenicity. CONCLUSIONS: The long-term durability and biological adaptation of ePTFE as artificial chordae for mitral valve repair of MR were proved for >10 years.

Adolescent↗
PubMed1980

Contribution of dynamic vascular wall thickening to luminal narrowing during coronary arterial constriction.

Available estimates of the ratio of wall thickness to luminal radius of human coronary arteries and certain geometrical assumptions were used to calculate the amounts of vascular smooth muscle shortening required to produce specific changes in luminal diameter for hypothetical "normal" and stenotic arteries. The results indicate that even modest mural thickening due to disease may act as a "lever" in translating physiologic degrees of medial smooth muscle shortening into critical luminal obstructions, providing the diseased segment maintains some pliability. The possibility of acute luminal occlusion occurring at stenotic sites as the result of "normal" vasomotion is illustrated. The appropriate use of the term coronary arterial "spasm" is discussed in light of these observations.

Adult↗
PubMed2000

Glottal area waveform analysis of benign vocal fold lesions before and after surgery.

Glottal area waveform (GAW) is the plot of relative glottal area versus time through 1 representative glottal cycle. It is derived from the quantitative analysis of the videostroboscopic image. A GAW analysis was performed on 24 patients before and after microlaryngeal phonosurgery. Patients with vocal fold polyps, polypoid degeneration, cysts, sulcus vocalis, and Reinke's edema were included. From each GAW, 5 parameters were determined and compared: maximum normalized glottal area, maximum opening rate, maximum closing rate, percent open time at 50% glottal opening, and glottal gap size. Statistically significant differences in postoperative states included an increased maximum glottal area, an increased maximum opening rate, and an increased maximum closing rate. Glottal opening and closing rate are objective measures of vocal fold pliability that have clinical relevance. The GAW may be used to quantitate vocal fold vibratory capability.

Female↗
PubMed2001

Stroboscopic assessment of vocal fold keratosis and glottic cancer.

Disruption of the normal viscoelastic properties of the superficial lamina propria (SLP) results in aberrant vocal fold vibration and mucosal wave propagation. Therefore, an investigation was performed to determine whether stroboscopy is a reliable method for 1) differentiating invasive glottic carcinoma from intraepithelial atypia or 2) determining the depth of cancer invasion. An analysis was done on the preoperative vocal fold vibration characteristics of 62 keratotic (intraepithelial, 45; cancer, 17) lesions that were subsequently resected by means of microlaryngoscopy. Histopathology and intraoperative mapping were used to specify the depth of invasion. A panel of 4 blinded judges was used to assess the amplitude of vocal fold vibration and the magnitude of mucosal wave activity in the region of the lesion from videostroboscopic recordings. The final comparative data set comprised only those ratings that achieved at least 75% interjudge agreement. Of the 28 intraepithelial lesions that could be reliably evaluated for amplitude of vocal fold vibration, only 2 were normal, with the amplitude reduced in 24 and absent in 2. Of the 30 intraepithelial lesions in which mucosal wave activity could be reliably assessed, only 2 were normal, with the wave reduced in 24 and absent in 4. Furthermore, amplitude of vocal fold vibration and magnitude of mucosal wave propagation were absent in 2 of 4 carcinomas in which the depth of microinvasion did not reach the vocal ligament. According to the findings herein, reduced amplitude of vocal fold vibration and/or mucosal wave propagation associated with keratosis did not reliably predict the presence of cancer or the depth of cancer invasion into the laminae propriae. However, the presence of a flexible mucosal wave probably indicates that there is not extensive vocal ligament invasion. Reductions in the amplitude of vocal fold vibration and in mucosal wave magnitude were usually noted in intraepithelial atypia, despite the fact that there was no invasion into the SLP. The reduced epithelial pliability could be due to bulky keratosis and/or alteration of the SLP occurring as a result of inflammation or fibrovascular scarring.

Carcinoma, Squamous Cell↗