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Proton T1 study of coverage parameter changes in tissues from tumor-bearing mice.

measurements of water proton spin-lattice relaxation time, T1, at 20 and -15 degrees C have been performed in spleen, kidney, liver, and muscle tissues from tumor-bearing mice, as well as in tumors grown in their dorsal subcutaneous tissues. All mice used were either from the C3H/HeJ or BALB/c strain. At - 15 degrees C the T1's of tissues of a given type from tumor-bearing and healthy mice are essentially the same. It is shown that in spleen the increased T1 from tumor-bearing mice can only be explained in terms of a large change in the water coverage parameter of macromolecules. In liver, muscle, and tumors the increased water content accounts for the changes in T1, while kidney represents an intermediate case.

Animals

Cross-foot flap for ankle coverage.

The usual cross-leg flap procedures to cover composite wounds involving exposed ankle joint or bone require awkward positioning of the extremities with resultant complications. This is especially true in young, muscular patients with thick legs. A dorsalis pedis flap from the uninjured foot used as a cross-foot flap has been reliable and successful in our experience. A representative case history and the multiple advantages of this technique are described. We believe that this flap is an excellent alternative to the free-flap technique for coverage around the ankle area, especially in hospitals in which facilities for free-flap technique are not available.

Adult

Methods of vascular pedicle coverage.

Based on our clinical experience, various methods of donor or recipient vascular pedicle coverage for an arterialized or free flap are reported. The vascular pedicle may be placed in the subcutaneous space either by incising the skin along the full length of the vascular route or by passing it through a subcutaneous tunnel. It has been our experience that the vascular pedicle can also be covered by either a local flap or a free skin graft. On rare occasions, a narrow skin flap strip including the vascular pedicle can be lifted en bloc and rotated toward the base of the area transferred.

Adult

Utilization of supervised physician's assistants in emergency room coverage in a small rural community hospital.

A study has been made of an initial 2-year experience in a 90-bed rural community hospital where emergency room primary coverage has been provided by Physician's Assistants under supervision of specialists in the field of general surgery, pediatrics, and internal medicine. Emphasis has been placed on a rigidly supervised program as well as physician supervision and availability on a patient-call basis. This supervision may take the form of immediate availability of the physician to the emergency room, telephone consultation or, in minor illnesses and injuries, continued review of the record of each individual patient seen by the Physician's Assistant. A review of the most recent 2-month ER-OPD experience showed that in a small rural hospital, a majority (62%) of the patients had an illness or injury of a minor, nonserious degree which could be handled primarily by a Physician's Assistant. This has led to emergency room care which has been judged by the patients, the emergency-room nurses, and the supervising physicians to be more efficient and prompt than had been previously provided, yet not reduced in quality. The program described was developed by physicians active in private practice working with the Physician's Assistants and RN's in the ER-OPD. The physicians' time spent in teaching, supervision and development of written policy was great, and, at times, threatened the continuation of the program. A fulltime physician in the hospital could better initiate the program of teaching, supervision, formulating written procedures, and establishing policies with different specialist.

Consumer Behavior

Use of a cross-forearm neurocutaneous flap to provide sensation and coverage in hand reconstruction.

A cross-forearm, neurocutaneous flap has been used in certain clinical situations to restore coverage and sensation over hand defects. Based on the superficial branch of the radial nerve, this flap provides a combination of handlike skin and subcutaneous tissue with sensation, which can be transferred. A fascicular neurorrhaphy between the superficial branch of the radial nerve and an appropriate recipient nerve stump has resulted in new epicritic sensation in the reconstructed area.

Adult

Multiple flap coverage for degloving hand injuries.

A technic incorporating the simultaneous elevation of multiple adjacent thoracoabdominal pedicale flaps, based in opposite directions, has been successfully used on four patients with extensive degloving injuries of the hand. In all cases, the hand was later divided into individual digits. A five-year follow-up of three patients is presented, illustrating functional results good enough to allow the patients to return to work. The special problems of a circumferential wound and digital shortening appear to be better controlled by this technic than by a single long "wrap-around" flap. Various technics of skin coverage are reviewed.

Adult

Preservation of a radionecrotic larynx by excision of thyroid cartilage with flap coverage.

Necrosis of the larynx following radiation therapy is a rare complication leading to severe disability and even death. Generally accepted treatment has consisted of incision and drainage, debridement, and tracheotomy or even total laryngectomy. One patient developed chondronecrosis of the thyroid cartilage and was treated by excision of the entire thyroid cartilage and overlying skin with subsequent coverage by a unipedicled cervicothoracic flap. The patient has had his tracheotomy corked or been decannulated for 11 months with preservation of a useable larynx.

Carcinoma, Squamous Cell

Pension coverage and benefits, 1972: findings from the retirement history sutdy.

This article, based on data from the Retirement History Study, examines coverage by an employee pension plan on the longest job and the extent to which covered workers received an employee pension upon retirement and the size of their benefits. It also examines the joint receipt of employee pension and OASDI benefits and the size of the combined benefits. Each of these pension variables is analyzed for differences by class of worker (private wage and salary or government), sex, and characteristics of the longest job (industry, occupation, tenure, recency of job, extent of employment, and annual earnings rate). The majority of completely retired individuals in their early to middle sixties in 1972 did not receive employee pension benefits in that year. Women employed in private industry on their longest job were the most disadvantaged in this regard. Even when they were fortunate enough to receive retirement benefits from employee pension plans, their benefits were substantially lower than those of men or of women employed in government.

Aged

Coverage of a shoulder wound with a deltoid muscle flap.

An unusual and severe injury to the soft tissues of the shoulder with exposure of the humeral head and glenohumeral joint is presented. The principles of muscle transposition were applied to rotation of the deltoid muscle in achievement of wound closure. Healing was rapid and satisfactory, and a useful upper extremity was salvaged.

Adolescent