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At least 613 records · Page 34Linked to original sources
PubMed1984

Extragenital split thickness skin graft for urethral reconstruction.

The reconstructive surgeon often is called upon to correct a severe deformity after previous operative attempts have failed, leaving a scarred and ischemic surgical field. A successful result requires an innovative operative approach and thorough knowledge of the established principles, as well as willingness to apply and to modify them. Frequently, one is faced with the so-called hypospadias crippled in whom little acceptable genital skin is available for urethral and penile reconstruction. When a salvage procedure is necessary in these instances we have used a free split thickness graft of extragenital skin. This technique was used in 11 male patients between 8 and 21 years old, the majority of whom were seen after multiple failed hypospadias or epispadias repairs. Complications included urethral stricture in 2 boys and fistula in 2 others. Long-term results have been excellent with a followup of 4 years. Although this procedure has not been accepted widely in the past, we believe that it can be useful if several important technical points are observed. This method is a useful addition in a salvage situation for urethral reconstruction when local skin is not available.

Adolescent↗
PubMed1982

Peyronie's plaque: excision and graft versus incision and stent.

Nineteen patients with Peyronie's plaque unsuccessfully treated conservatively were considered surgical candidates. Although all patients had erections intercourse was functionally difficult to impossible for most. Only 30 per cent of the patients who underwent plaque excision and grafting became sexually functional postoperatively. Placement of penile prostheses appears to be the most secure method to rehabilitate the male patient who has become a sexual cripple secondary to Peyronie's plaque.

Adult↗
PubMed1979

Dermal graft repair of Peyronie's disease: survey of 50 patients.

Peyronie's disease is characterized by localized fibrosis in the tunica albuginea of the corpus cavernosum. This inelastic segment causes bending of the erect penis and sexual incapacity in advanced cases. We reviewed 52 cases in which excision of the Peyronie's plaque and replacement of the defect with a dermal graft have been done. An operation is an acceptable method to treat patients who are anatomic and sexual cripples. More than 70 per cent of our postoperative patients have been satisfied with sexual performance. Specific aspects of the postoperative course and surgical results are reviewed.

Adult↗
PubMed1977

Renal lithiasis: a practical approach.

Management of most patients with calculous disease has been less than ideal in the past. Too often therapeutic efforts were limited to symptomatic calculi. Stones were allowed to pass or were removed, metabolic studies were incomplete, victims were dismissed and forgotten, and prophylactic measures were negligible and usually confined to milk restriction and use of distilled water. More patients were crippled with and died of recurrent calculous disease, urinary infection and progressive renal insufficiency than from any other upper urinary tract abnormality. During the last decade the development of a renal stone clinic at this institution has allowed a nephrourologic approach to the management of urolithiasis. This account of classification, diagnosis and management of the various syndromes associated with urolithiasis is based on the experiences gained during the last decade with this common but ill-understood urologic problem.

Acidosis, Renal Tubular↗
PubMed1997

Zinc and metallothioneins on cellular immune effectiveness during liver regeneration in young and old mice.

Partial hepatectomy in young mice (pHx) induces thymic atrophy, disregulation of thymocytes subsets and a strong accumulation of zinc in thymic tissue after 1-2 days of liver regeneration. Zinc is relevant for good immune functioning. Restoration of zinc into both the thymus and thymocytes subsets in the late period of liver regeneration is observed in young pHx mice. These findings have suggested a link between the thymus and the liver influencing T-cell functions and involving zinc. This kind of link could be relevant in aging because thymic involution, negative crude zinc balance and crippled immune functions are constant events. The preminence of a liver extrathymic T-cell pathway after pHx or during aging has been suggested. Thus the study of pHx in young and old mice may offer a good model to better understand the role played both by thymic involution and by liver extrathymic T-cell pathway and the role of zinc in these physiological processes during aging. Young pHx mice after 1-2 days of liver regeneration show: reduced thymic endocrine activity, increment of double negative (DN) thymocytes subsets, impairment of peripheral immune efficiency (PHA, NK activity and IL-2) and negative crude zinc balance, which are all restored in the late period of liver regeneration. By contrast the thymic and peripheral immune defects and the negative crude zinc balance, already present in old sham mice, are not modified during liver regeneration in old pHx mice. Circulating leukocytes and lymphocytes are not significantly modified both in young and old pHx mice as compared to respective sham controls. Zinc may also be crucial for extrathymic T-cells pathway, being preminent in aging, rather than in young age, due to its metallothioneins (MT) binding capacity. MT are significantly increased in young pHx and in aging inducing a low zinc-free quota for thymic and peripheral immune efficiency in young pHx mice, and for extrathymic T-cell pathway, in old age. Thus low zinc bioavailability, due to MT, may play a pivotal role, not only for thymocytes but also for liver extrathymic T-cell pathway.

Aging↗
PubMed1985

Mechanisms of action and clinical applications of cytotoxic drugs in rheumatic disorders.

Failure to suppress disease activity in certain rheumatic disorders such as systemic lupus, polyarteritis nodosa, or Wegener's granulomatosis may significantly heighten the probability of a fatal outcome. In other rheumatic disorders (for example, rheumatoid or psoriatic arthritis) the disease left unchecked may indeed be severely crippling but rarely is it fatal. Thus the decision on whether to add a cytotoxic drug often evolves into a benefit-to-risk analysis, a decision in which the patient must also be intimately involved. There are two few well-controlled studies of the use of cytotoxic agents to make dogmatic statements regarding their use in the treatment of rheumatic disorders. Nevertheless, a review of the literature, some of which has been cited above, does permit one to make some reasoned judgments in choosing a drug for a particular disease (Table 2).

Arthritis, Reactive↗
PubMed1977

Chronic oxygen therapy.

Chronic low flow oxygen is useful therapy for patients with chronic obstructive lung disease who are crippled by hypoxemia despite optimal programs of usual respiratory care. Patients should be considered for chronic oxygen therapy who have (a) a resting Pao2 less than 55 mm Hg while breathing room air; or (b) profound tissue hypoxemia measured by mixed venous Pao2 and suggested by symptoms such as cor pulmonale and congestive heart failure; or (c) pulmonary hypertension or polycythemia even though daytime Pao2 is greater than 55 mm Hg. Arterial blood must be obtained to demonstrate hypoxemia and assess the benefits of oxygen therapy. Patients on chronic oxygen must remain under close medical supervision. There are no absolute contraindications to chronic oxygen therapy, other than refusal of the patient to quit smoking. Complications of therapy appear to be negligible. The exciting suggestion of improved prognosis in patients with chronic obstructive lung disease on oxygen therapy and the possibility of delaying the long-term sequelae of chronic respiratory failure bear careful watching in the future.

Acidosis, Respiratory↗
PubMed1984

Children with chronic asthma: care by the generalist and the specialist.

We have come a long way since 1882 when Dr. Henry Salter published his treatise, On Asthma: Its Pathology and Treatment. His task then was even more complex than ours is today. He not only worked alone in a medical void, providing care for over 200 patients with chronic asthma, but he also suffered from the same disease. But not only is asthma not an uncommon disease, but it is one of the direst suffering; the horrors of the asthmatic paroxysm far exceed any acute bodily pain; the sense of impending suffocation, the agonizing struggle for the breath of life, are so terrible, that they cannot even be witnessed without sharing in the sufferer's distress. With a face expressive of the intensest anxiety, unable to move, speak, or even make signs, the chest distended and fixed, the head throne back between the elevated shoulders, the muscles of respiration ridged and tightened like cords, and tugging and straining for every breath that is drawn, the surface pallid or livid, cold and sweating--such are signs by which this dreadful suffering manifests itself. And, even in the intervals of health the asthmatic's sufferings do not cease; he seems well, he goes about like his fellows and among them, but he knows that he is altogether different from them; he bears about his disease within him wherever he goes; he knows he is struck; he is conscious that he is not sound--he cannot be warranted; he is not certain of a days, perhaps not of an hours health; he only knows that a certain percentage of his future life must be dedicated to suffering; he cannot make an engagement except with a proviso, and from any of the occupations of life he is cut-off; the recreations, the enjoyments, the indulgences of others are not for him; his usefulness is crippled, his life is marred; and if he knows anything of the nature of his complaint he knows that his sufferings may terminate in a closing scene worse only than the present. Today, this need not be the case.

Asthma↗
PubMed2003

Neuroactive and other free amino acids in seed and young plants of Panax ginseng.

The seeds and one to three years old plants of Asian ginseng (Panax ginseng C.A. Meyer) were analyzed for their free amino acid contents. The neuro-excitatory beta-ODAP (beta-N-oxalyl-L-alpha,beta-diaminopropionic acid), suggested to be the cause of the crippling neurolathyrism, was the major component in the seed extract (70% of the total free amino acids detected) and showed the highest concentration (0.43% by wt) compared to that in the different parts of young plants. beta-ODAP concentration was higher in the shoots as compared to roots and declined in older plants. The amount of beta-ODAP in the roots may be considered as an indirect measure of age and quality. Another neuro-active non-protein amino acid, GABA (gamma-aminobutyric acid), increased dramatically after germination and reached highest concentration in different parts of 3 year-old plants. Glutamine and arginine were the two major free proteinogenic amino acids in the ginseng plants and together they constituted over 50% of all the free amino acids detected in the root.

Amino Acids↗
PubMedDate not supplied

High death rates in health care workers and teachers in Malawi.

High death rates are reported in health care workers (HCWs) and teachers in urban areas of Malawi. The present study was carried out to determine the annual death rate in HCWs and primary school teachers working in semi-urban and rural areas of Malawi, and to try to ascertain the main causes of death. Forty district and mission hospitals in Malawi were visited. A record was made of the number of clinical and nursing-based HCWs in each hospital in 1999, the number of deaths in that calendar year and reported causes of death. A record was also made of the number of teachers working in 4 primary schools nearest to each hospital in 1999, the number of deaths in that calendar year and reported causes of death. There were 2979 HCWs, of whom 60 (2.0%) died. There were 4367 teachers of whom 101 (2.3%) died. Annual death rates, calculated per 100,000 people, were significantly higher in male HCWs compared with female HCWs (2495 versus 1770, RR 1.17, 95% CI 1.14-1.20, P < 0.001), and significantly higher in female teachers compared with male teachers (2521 versus 1934, RR 1.14, 95% CI 1.11-1.17, P < 0.001). In male HCWs and teachers the highest death rates were in those aged 35-44 years. In female HCWs and teachers, the highest death rates were in those aged 25-34 years and 35-44 years, respectively. Reported causes of death in HCWs were tuberculosis (TB) in 47%, chronic illness in 45% and acute illness in the remainder, while in teachers the causes were TB in 27%, chronic illness in 49% and acute illness in 25%. Chronic illness, thought to be due to AIDS, and TB were the common causes of death. The current high death rates from AIDS and TB will have a crippling toll on the health and education sectors, and effective ways of reducing these death rates must be found.

Acute Disease↗
PubMed1997

Esophageal replacement for end-stage benign esophageal disease.

The fact that esophageal resection and foregut reconstruction for benign disease can be performed with only a 2% mortality and minimal morbidity is encouraging news to patients who are crippled by the various manifestations of end-stage disease. The continuation of slow, anxious, and socially restricted alimentation or the maintenance of nutrition by enteral or parenteral means is unnecessary. The patient should be referred to a unit skilled in evaluating foregut function, performing esophageal replacement surgery, and caring for patients in the perioperative period. In our experience, the colon, when available, is the preferred conduit for esophageal replacement over the long term. Even though some subtle preoperative symptoms of foregut dysfunction may persist after surgery, the overall outcome is generally judged to be satisfactory. Indeed, patients can re-enter society and live a normal and fulfilled life after remedial surgery. Prolonged attempts at medical management of patients with severe derangements of esophageal structure and function are not warranted. Long-term esophageal replacement for severe end-stage benign disease can be accomplished with low mortality, a high degree of success, and a marked improvement in the quality of alimentation. Reconstruction restores the pleasure of eating and is viewed by the patient to be highly successful.

Colon↗
PubMed1995

Aortic and extracranial large vessel giant cell arteritis: a review of 72 cases with histopathologic documentation.

Giant cell arteritis (GCA) is closely identified with the temporal arteritis-polymyalgia rheumatica syndrome of the elderly. It is also a systemic disease that can cripple and kill. Up to 15% of patients with temporal arteritis may have angiographic evidence of extracranial GCA, and aortic insufficiency, ruptured aortic aneurysm, aortic dissection, stroke, or myocardial infarction may be the initial manifestation of systemic GCA. A review of 72 cases of aortic and extracranial GCA, all with histopathologic verification of the disease, revealed that 25% of patients with aortic and extracranial large-vessel GCA had asymptomatic temporal arteritis; the ascending aorta and aortic arch were most frequently involved (39%), followed by the subclavian and axillary arteries (26%), and the femoropopliteal arteries (18%). Nine patients (12.5%) underwent an upper or lower limb amputation. Of the 18 patients whose death was directly attributable to extracranial GCA the causes were ruptured aortic aneurysm (6), aortic dissection (6), stroke (3), and myocardial infarction (3). The findings of these 72 cases caution against attributing all aortic and large-vessel arterial disease in the elderly to atherosclerosis and emphasize that timely surgical intervention may be necessary for life-saving and limb-salvage in patients with aortic and extracranial GCA.

Aged↗
PubMed2000

The indispensable role of microenvironment in the natural history of low-grade B-cell neoplasms.

Follicular lymphoma (FL) and B-cell chronic lymphocytic leukemia (B-CLL) are paradigmatic examples of lymphoid malignancies in which the relevant biological mechanisms are alterations in the control of apoptosis rather than an exaggerated proliferation. This explains why low-grade B-cell neoplasms still fail to be cured with current approaches. It is becoming increasingly clear that the defective apoptosis of FL and B-CLL has to be ascribed not only to intrinsic defects of the neoplastic cells, but also to extrinsic factors that influence their behavior. Malignant B cells retain the capacity to respond to microenvironmental signals, but have devised a monothematic responsiveness. They have a specific sensitivity to anti-apoptotic signals that favor their survival, whereas they seem to have become insensitive to pro-apoptotic signals. Bystander, nontumoral cells play a fundamental (though not sufficient) role both in the onset and in the progression of these diseases. The survival of leukemic cells appears to be dependent on direct cell-cell contacts. The localization of malignant B cells in bone marrow or neoplastic follicles is not a passive adhesion phenomenon but a crucial step for their survival. Bidirectional malignant lymphocyte-nontumoral cell interactions may lead to the amplification of a microenvironment able to inhibit the apoptosis of neoplastic B cells. The pressure of antigenic selection and the role of the tumor necrosis factor receptor family through the functional survival signal provided by CD40 together with the crippled death signal exerted by CD95 are new prominent characters on the stage.

Antigens, CD↗
PubMed2002

Molecular biology of Hodgkin's lymphoma.

Hodgkin's lymphoma (HL) is characterized by typical mononucleated Hodgkin and multinucleated Reed-Sternberg cells, which occur at low frequency in a mixed cellular infiltrate in the tumor tissue. Because of the rarity of these cells and their unusual immunophenotype, which is strikingly different from those of all normal hematopoietic cell types, the origin of these cells and their clonality have long been unclear. Single-cell studies of rearranged immunoglobulin genes showed that Hodgkin and Reed-Sternberg (HRS) cells represent clonal tumor-cell populations derived from germinal center B cells. In classical HL, the detection of obviously crippling immunoglobulin gene mutations in a fraction of the cases suggests that HRS cells may derive from germinal center B cells that have lost the capacity to be positively selected by antigen and that normally would have undergone apoptosis. In rare cases, HRS cells represent transformed T lymphocytes. The transforming events involved in malignant transformation of HRS cells are still largely unknown. Constitutive activation of the transcription factor NFkappaB, which can, for example, be induced through Epstein-Barr virus transformation of HRS cells or destructive somatic mutations of the inhibitor of NFkappaB, is likely to be a key event in HL pathogenesis. Significant progress has been made in our understanding of the cellular interactions in HL tissues, which are mainly mediated by a large variety of cytokines and chemokines.

Antigen-Presenting Cells↗
PubMed2002

Bone growth stimulators. New tools for treating bone loss and mending fractures.

In the new millennium, humans will be traveling to Mars and eventually beyond with skeletons that respond to microgravity by self-destructing. Meanwhile in Earth's aging populations growing numbers of men and many more women are suffering from crippling bone loss. During the first decade after menopause all women suffer an accelerating loss of bone, which in some of them is severe enough to result in "spontaneous" crushing of vertebrae and fracturing of hips by ordinary body movements. This is osteoporosis, which all too often requires prolonged and expensive care, the physical and mental stress of which may even kill the patient. Osteoporosis in postmenopausal women is caused by the loss of estrogen. The slower development of osteoporosis in aging men is also due at least in part to a loss of the estrogen made in ever smaller amounts in bone cells from the declining level of circulating testosterone and is needed for bone maintenance as it is in women. The loss of estrogen increases the generation, longevity, and activity of bone-resorbing osteoclasts. The destructive osteoclast surge can be blocked by estrogens and selective estrogen receptor modulators (SERMs) as well as antiosteoclast agents such as bisphosphonates and calcitonin. But these agents stimulate only a limited amount of bone growth as the unaffected osteoblasts fill in the holes that were dug by the now suppressed osteoclasts. They do not stimulate osteoblasts to make bone--they are antiresorptives not bone anabolic agents. (However, certain estrogen analogs and bisphosphates may stimulate bone growth to some extent by lengthening osteoblast working lives.) To grow new bone and restore bone strength lost in space and on Earth we must know what controls bone growth and destruction. Here we discuss the newest bone controllers and how they might operate. These include leptin from adipocytes and osteoblasts and the statins that are widely used to reduce blood cholesterol and cardiovascular damage. But the main focus of this article is necessarily the currently most promising of the anabolic agents, the potent parathyroid hormone (PTH) and certain of its 31- to 38-aminoacid fragments, which are either in or about to be in clinical trial or in the case of Lilly's Forteo [hPTH-(1-34)] tentatively approved by the Food and Drug Administration for treating osteoporosis and mending fractures.

Animals↗
PubMed2002

Hypospadias in adults.

OBJECTIVES: To review the follow-up data and complications of adult patients who underwent hypospadias surgery. METHODS: The records of 88 male patients with an average age of 21.9 years (range 20 to 27) who were operated on for hypospadias from 1996 to 2001 were reviewed in two groups: primary cases and all others (at least one unsuccessful attempt to correct the hypospadias). The primary cases consisted of 48 anterior, 9 middle, and 2 proximal hypospadias; the second group consisted of 16 urethrocutaneal fistula, 8 hypospadias, and 5 cripple cases. RESULTS: The complication rate was 10.1% for the first group and 27.5% for the second group. After the second intervention in groups 1 and 2, the overall success rate was 100% and 89.6%, respectively. CONCLUSIONS: Adult hypospadias is repaired with the techniques used in pediatric cases. However, the postoperative complication rate is higher, and these patients more often require multiple interventions.

Adult↗
PubMed2003

Brachial plexus injuries.

Severe trauma to the brachial plexus most often occurs in young adult men and is a crippling injury that requires management in a timely fashion for optimal functional recovery and pain control. The surgical management of such injuries is well established, and the techniques continue to evolve. Current management options consist of primary repair in the acute setting, neurolysis, neuroma resection and nerve grafting, motor and sensory nerve transfers, and muscle and tendon transfers. Shoulder andwrist fusion can also play a role in the overall management of these patients. The best operative plan varies depending on the patient's level and extent of injury and the surgeon's preference and experience. The pre- and postoperative care of these patients is ideally managed by a team that has experience with such problems, including personnel knowledgeable in their postoperative rehabilitation. The total reconstructive process generally consists of more than one operation, and the postoperative rehabilitation is long and intensive. Nevertheless, with a highly motivated patient and a dedicated and specialized surgical team, the prognosis for functional recovery is good, and these patients can still lead productive and satisfying lives.

Brachial Plexus↗
PubMed1988

Multidisciplinary team approach to the pediatric burn patient.

Burn trauma is the most devastating injury the body can sustain. Each year, 100,000 victims will sustain burn injuries serious enough to require hospitalization; 35% of these victims are children. The Shriners Hospitals for Crippled Children Burns Institute, Cincinnati Unit (SBI-Cincinnati), is a 30-bed hospital with all of the support systems of a major university medical center. SBI-Cincinnati uses a multidisciplinary team approach to family-centered care. The primary nurse and physician collaborate with the rest of the health care team to manage all aspects of care. This approach assures that coordination of care occurs and allows the family the opportunity to maintain a unique role as the primary caregiver.

Adolescent↗