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At least 811 records · Page 45Linked to original sources
PubMed1979

Immediate reconstruction of gunshot injuries to the face.

In the past, severe traumatic injuries to the face resulting from shotgun injuries have been managed by primary wound healing followed by little or late reconstruction. This would involve a long period of convalescence by the patient, followed by years of living with his deformity. With recent demands to minimize the patient's suffering and disabilities and to lessen hospitalization costs, a method of immediate reconstruction of such crippling facial injuries using a partially de-epithelialized skin flap has been devised and successfully applied to the patient presented here.

Adult↗
PubMed1985

Can collagen metabolism be controlled: theoretical considerations.

Pharmacologic alterations of the inflammatory response and collagen metabolism will lead to control of the many disease states of fibrosis. Many of these diseases kill and cripple far more than hypertrophic scar. Far too little research is being directed in this area. The objectives of controlling fibrosis by interfering with collagen crosslinking were defined clearly by Peacock. Perhaps topical BAPN will be the first agent to bring a practical clinical reality to his predictions made over 20 years ago.

Aminopropionitrile↗
PubMed1998

Single and multiple dermal grafts for the management of severe penile curvature.

PURPOSE: Conventional techniques result in chordee correction in the majority of patients. However, some with extensive chordee require further treatment to correct persistent extraordinary penile curvature. Our practice has been to treat this condition with interpositional dermal grafting. We review our experience with this procedure. MATERIALS AND METHODS: During a 5-year period dermal grafts harvested from the nonhair-bearing inguinal skin fold were placed in 51 patients with a mean age of 29 months. The primary diagnosis was penoscrotal or perineal hypospadias in 36 patients (hypospadias cripple in 4), the exstrophy-epispadias complex in 3, mid shaft or distal hypospadias with severe chordee in 10 and chordee without hypospadias in 2. A total of 49 patients (96%) underwent staged urethroplasty. RESULTS: One graft was placed in 29 patients (57%), 9 (18%) received 1 graft and underwent a Nesbit plication, (14%) received 2 grafts, 5 (10%) received 2 grafts and underwent dorsal plication, and 1 (2%) received 3 grafts. Second stage urethral reconstruction was done using a Thiersch-Duplay tube in the majority of cases. In 5 patients mild residual chordee was easily corrected at the time of second stage repair. CONCLUSIONS: In a staged repair the first priority of the initial stage is to achieve a straight phallus. While our experience indicates that a single dermal graft is sufficient in approximately 57% of cases, when it does not result in complete straightening, we have had success with placing additional graft(s) and/or performing dorsal plication. We believe that the additional penile length achieved with dermal grafting results in a dependent phallus and cosmesis preferable to that of plication only.

Adolescent↗
PubMed1996

Orbicularis oris muscle injury in brass players.

The embouchure of the brass player is critical to tone production and largely depends on the integrity of the orbicularis oris muscle. Injury to this muscle can cripple the professional musician by causing fatigue, pain, and tonal deterioration. Ten brass players presented with muscular defects in the orbicularis oris muscle. Examination identified areas of abnormality within the muscle and electromyography (EMG) ruled out a neurologic deficit. All patients underwent exploration under neuroleptic anesthesia, and 9 patients underwent repair. The technique is described. The repaired patients reported improvement after the operation and all resumed playing at their premorbid level. The 10th patient was found to have thinning of the entire orbicularis oris muscle (presumably congenital) and was not able to be repaired. There were no complications of the procedure and no recurrences.

Adult↗
PubMed1997

Experience with segmental reconstruction of the radiated mandible with alloplastic prostheses.

Reconstruction of the mandible after radiation therapy and segmental resection is often complicated by wound breakdown, osteoradionecrosis, and crippling of the oral cavity. These complications make patient salvage after radiated oral carcinoma a high-risk endeavor. Although head and neck surgeons have improved the reliability of mandibular reconstruction with microvascular free tissue transfer, medical and oncologic issues may prohibit their application. This report presents 12 selected cases undergoing alloplastic reconstruction of the mandible and soft tissue reconstruction of the oral cavity. Although not as reliable as some reports of free tissue transfers, the results were reproducible and satisfactory in these cases, with time-efficient hospitalization and functional rehabilitation. Ten of 12 prosthetic reconstructions have been durable in this study population for as long as 36 months.

Aged↗
PubMedDate not supplied

Theoretical perspectives of postpartum depression and their treatment implications.

Approximately 13% of new mothers experience postpartum depression. This crippling mood disorder wreaks havoc not only on the mothers themselves but also on their entire families. Between 25% and 50% of mothers with postpartum depression have episodes lasting 6 months or longer. The most significant factor in the duration of the postpartum depression is the length of delay to adequate treatment. The purpose of this article is to describe five different theoretical perspectives of postpartum depression and the interventions for treatment derived from each: the medical model, feminist theory, attachment theory, interpersonal theory, and self-labeling theory. Crucial to clinicians' choice of treatment of postpartum depression is the theoretical lens they use to view this devastating mood disorder. Nursing implications derived from these theoretical perspectives are addressed.

Depression, Postpartum↗
PubMed1996

Bypass coaptation procedures for cervical nerve root avulsion.

In the past, patients with cervical spinal nerve root avulsions were resigned to accept a natural crippling from upper extremity neurological deficits. Recently, bypass coaptation procedures have resulted in functional return of denervated muscles after such avulsions, much to the appreciation of patients. Presented are 12 patients with avulsion of cervical spinal nerve roots that form either the brachial plexus upper trunk (n = 7), lower trunk (n = 1), or all three trunks (n = 4). The patients underwent the new bypass coaptation procedures with complete or partial return of motor and sensory function, which otherwise would be totally nonfunctional. The most dramatic results were noted in those patients who underwent operations within 6 weeks of injury. The results of these procedures offer patients a valid therapeutic modality for an enhanced quality of life after cervical nerve root avulsion.

Adult↗
PubMed1982

Pathophysiology of rheumatoid arthritis.

Understanding the pathophysiologic joint changes of rheumatoid arthritis will help the nurse practitioner educate clients in therapeutic modalities such as drugs, exercise, rest, heat and cold, and splints. Uncontrolled inflammation of the affected joints is the client's worst enemy. If inflammation could be controlled early in the disease process and thus limited to synovial tissue without pannus formation and subsequent cartilage destruction, normal joint function could be more optimally maintained. But once fibrotic tissue has formed, the resulting damage to the cartilage and joint destruction cannot be reversed. The earlier treatment is initiated and the sooner the client is educated, the less advanced and crippling this disease could be physically, psychologically, emotionally and socially.

Anti-Inflammatory Agents↗
PubMed1993

Skeletal scintigraphic findings in endemic skeletal fluorosis.

Endemic skeletal fluorosis is characterized by bone, joint and muscle pain, progressive ankylosis of various joints and crippling deformities. Whole body skeletal scintigraphy with 99Tcm-methylene diphosphonate was performed for 17 symptomatic subjects suffering from this disorder. The fluoride content of drinking water ranged from 4.1 to 12.9 mg l-1 (normal < 1 mg l-1). Urinary and serum fluoride levels were markedly elevated. Serum calcium (total and ionized), inorganic phosphorus, creatinine and albumin were essentially normal while serum alkaline phosphatase was elevated in six subjects (mean +/- S.D. 206 +/- 106; range 22-1072 IU l-1). Skeletal radiology revealed a wide spectrum of bony abnormalities. Skeletal scintigraphy revealed a picture similar to metabolic 'superscan' in all subjects, i.e. increased tracer uptake in axial and appendicular skeleton, reduced soft tissue uptake, poor or absent renal images, prominent costochondral junction and 'tie' sign in sternum. Increased uptake was present in all subjects irrespective of age, water fluoride content, serum alkaline phosphatase level and radiological abnormalities. Our findings suggest the presence of a high bone turnover state in endemic skeletal fluorosis irrespective of other variables.

Adolescent↗
PubMed1996

Results of three-phase bone scintigraphy and radiography in 20 cases of neonatal osteomyelitis.

Neonatal osteomyelitis, a rare, potentially crippling disease, requires early diagnosis and effective therapy. This study of 20 neonates analysed the diagnostic value of three-phase bone scintigraphy (motivated by its controversial role), plain radiography and local clinical signs in neonatal osteomyelitis and complicating septic arthritis. The sensitivities for detecting focal skeletal involvement were as follows: bone scintigraphy 90%, radiography 65%, clinical local signs 20%. Reliable scintigraphic signs were localized hyperperfusion (phase I), vasodilation (phase II) and hot or cold lesions on 3-h images. Radionuclide angiography definitely increased the validity of bone scintigraphy. During follow-up, the reduction or normalization in focal hyperperfusion was the first and most sensitive sign of an adequate response to antibiotic treatment; persistence (or recurrence) of focal hyperperfusion, increasing relative uptake ratios and the appearance of new foci of bone involvement indicated escape from antibiotic therapy. Radiography revealed no pathological signs in 35% of cases, soft tissue changes in 20% and effusion of the hip joint in 45%. Local clinical signs were not a reliable predictor of scintigraphic or radiographic findings. We consider bone scintigraphy in neonatal osteomyelitis to be a successful, efficient and cost-effective diagnostic modality, not only for early diagnosis, but also during follow-up.

Bone and Bones↗
PubMedDate not supplied

Chinese foot binding.

Chinese foot binding embraced several modern principles of brace treatment. It was initiated in childhood while the foot was cartilaginous and moldable. Culturally, the practice attempted to shape the foot into a pointed lotus flower. The resultant cavus foot deformity was dysfunctional and crippling. This curious custom, outlawed by the Communist party, is ironically analogous in some ways to high-heel shoe wear.

Beauty↗
PubMedDate not supplied

Vitamin D deficiency rickets in children: prevalence and need for community education.

Nutritional rickets caused by a deficiency in vitamin D can be a crippling disease and is still prevalent today. Many feel that the vitamin D supplementation present in dairy products prevents any risk of developing vitamin D deficiency rickets. However, a combination of factors such as pigmented skin, inadequate sunlight, breastfeeding past 6 months with no supplementation, and insufficient calcium intake by the nursing mother and her baby often contribute to rickets diagnosed in children. Educating the medical community and those families at risk is critical to eradicate this preventable disease. Steps can be taken using stages of the Organizational Change Theory to involve school nurses, community health centers, and pediatricians in identifying these high-risk children. With prompt diagnosis and treatment, all symptoms can abate, with healthy bone growth resulting.

Child↗
PubMed1979

Hypoglossal-facial nerve anastomosis for reinnervation of the paralyzed face.

The hypoglossal-facial nerve crossover is a valuable surgical procedure for the treatment of certain types of facial paralysis. It is most effective when used as an integral part of a primary ablative operation for the treatment of cancer in this region. In the treatment of long-standing facial paralysis, its application requires an intact peripheral facial nerve system and some functioning mimetic muscles with an obliterated proximal facial nerve segment. It is recognized that other procedures are available for repair in patients who meet essentially these same criteria. The disadvantages are minimal intraoral crippling, mass movements of the face and, in some instances, hypertonia of the face. The advantages are improved facial tone, protection of the eye, intentional facial movements controlled by the tongue, and movements associated with physiological functions of the tongue.

Adolescent↗
PubMed1999

Refinements in extracorporal septoplasty.

Septal deviations interfere with nasal airflow and contribute to deformities in the external appearance of the nose. An aesthetically and functionally satisfactory correction of severe septal deformities or "crippled" septal plates often requires a temporary intraoperative removal of the septal cartilage for appropriate remodeling. This article describes refinements to the previously described technique of extracorporal septoplasty; these refinements have proven useful and have made the procedure safer in the hands of less experienced surgeons. The refinements simplify the straightening methods for the explanted septal plate, achieving a stable and median fixation of the replanted septum while maintaining a satisfactory contour of the nasal dorsum. A milling cutter is used to straighten the irregularities of the explanted septal plate and to thin broadly based anterior nasal spines. When necessary, microplates are added to stabilize the osteotomized and medialized anterior nasal spine. The final positioning of the replanted septal plate is greatly enhanced by a rein stitch, transosseous sutures, and multiple quilt stitches. Additionally, direct fixation of the replanted septum to the edges of the upper lateral cartilages further improves the stability of the reconstruction. Finally, particular care should be taken to avoid residual irregularities of the nasal dorsum; it they occur, these irregularities can be covered with a thin cartilaginous splint or a layer of dehydrated fascia lata or autologous temporal fascia. A total of 436 patients who underwent rhinoseptoplasties at the authors' department during a 1-year period were reviewed. Of these patients, 108 presented with severe septal deviations and underwent an extracorporal septoplasty using the refined techniques described herein. Despite the complexity of the procedure, the patients' satisfaction rates were high, independent of the operating surgeon.

Humans↗
PubMed1986

Can Medicaid format alter emergency department utilization patterns?

Emergency department utilization by recipients of Aid to Families with Dependent Children (AFDC) in a metropolitan children's hospital was monitored during a 36-month period (July 1982 to June 1985). There were 92,495 emergency department visits recorded in this interval. During 12 months of this period (July 1983 to June 1984) a pilot program (Citicare) for AFDC recipients requiring prior authorization by the primary care physician for emergency department utilization was in effect. Emergency department census dropped dramatically and abruptly upon initiation of this program. Annual census for the targeted years reveals: 35,704 visits for the 12 months preceding this novel program, 25,543 visits for the 12 months of the program, and 31,248 visits for the 12 months following the pilot program. Total emergency department census was decreased by 23% and medical assistance utilization was decreased by 46% during the Citicare program. During the target period, self-pay clients decreased by 25%, and other categories (Champus, Hill-Burton, Crippled Children's Commission, etc.) increased by 6%. There was no corresponding decline in the number of patients admitted to the hospital through the emergency department during the monitoring period with 3,545, 3,555, and 3,922 annualized admissions respectively, for the targeted 12-month periods. These data suggest that the format of Medicaid programs can dramatically alter the utilization of emergency department services. Furthermore, the primary impact of this specific program was to decrease inappropriate emergency department use.

Aid to Families with Dependent Children↗
PubMed1978

Facial reanimation in Möbius syndrome.

The psychosocial deformity associated with total lack of facial animation (as seen in Möbius syndrome) is an extremely crippling situation. This inability to show happiness, sadness, or anger by facial expression frequently results in severe introversion and a reclusive personality. Restoration of even a minimal degree of controlled facial movement is beneficial. Recent experience in the treatment of two patients with this syndrome using both dynamic and static procedures has been most rewarding. Operating simultaneously on both sides of the face poses some problems that are different from those in teh patient with unilateral paralysis. The operative details are described, with preoperative and postoperative evaluation.

Adolescent↗
PubMed1981

Nutritional aspects of urolithiasis.

Although there is much concern about the relationship between vitamin C consumption and oxalate or uric acid lithiasis in the urinary tract, there is no controlled clinical study that demonstrates this occurrence. Equal concern should be accorded the other nutritional links to urinary lithiasis, since it is very unlikely that vitamin C or any one of the other factors is ever the sole cause of a kidney stone. The rare persons who, because of an altered metabolism, convert much of the ingested vitamin C into oxalic acid constitute the only high-risk category. If the other known nutritional variables were also investigated in these metabolically crippled persons, it might be possible to reduce or eliminate their risk from the intake of vitamin C.

Adult↗