[Energy requirements of the burned patient].
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Biomedical subjects
Publications and source records attributed to A R Moscona.
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BACKGROUND: Malignant melanomas (MMs) with a small diameter (less than 6 mm) are rarely removed surgically; therefore there is a need for more data to characterize them. OBJECTIVE: The purpose of this study was to further elucidate the clinical and histopathologic features of small melanomas. METHODS: The greatest diameters of 112 consecutively submitted MMs were measured histologically. Those lesions with diameters of less than 6 mm were further studied clinically and histopathologically. RESULTS: Four MMs (3.5%) were found to have small histologic diameters. Their clinical features differed from the classic clinical ABCD's, although their histopathologic features resembled those of large MMs. Their depth of dermal invasion was relatively superficial, and their clinical outcome was favorable. CONCLUSION: Histopathologically, small MMs tend to resemble large MMs, but clinically they may require other diagnostic criteria. Because they tend to show a relatively superficial depth of invasion, their increased recognition and removal may have an impact on overall mortality from MM.
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Twenty-one patients with hemangiomas on the face and lip who were treated with injections of sclerosing agents are discussed. The mode of action of these drugs was also studied experimentally on rats, which were injected through the pampiniform plexus of the spermatic cord. In the clinical study all patients showed satisfactory resolution of the hemangiomas with commensurate improvement in their appearance. The experimental study provides an explanation for the replacement of blood vessels by young connective tissue.
Severe genitoperineal trauma with total avulsion of testicles in a 7-year-old boy resulted from a road accident. Soft tissues were reconstructed by local flaps and skin grafts. The only testicle that was found was reimplanted in his biceps muscle in an attempt to restore endocrine function. A human chorionic gonadotropin test showed no response, indicating that the transplanted tissue did not survive.
A new type of fasciocutaneous flap, an "island fasciocutaneous flap", is presented. The anatomical basis of this flap and its advantages are discussed.
Reduced in vitro T cell mitogen-induced transformation, low proportion of T cells and increased proportion of non-T cells were found in blood mononuclear cells of patients with severe burns 3-12 days after the injury. High spontaneous proliferation of non-T cells was observed and could be related mainly to the B cell fraction. Monocytes mediated suppression of mitogen-stimulated T cell proliferation. We further studied the role of monocytes in the enhanced suppressor activity of Con A-activated T cells and found that in this assay system, the patient's T cells mediated suppression in collaboration with monocytes. In vitro, increased suppressor function was probably the result of in vivo stimulation of inhibitory activity ascribed to both monocytes and T cells of patients. Addition of indomethacin to cell cultures markedly reduced suppression of lymphocyte proliferation. Less significant reduction was noted when the patient's T cells were activated in vitro by Con A. Adjuvant treatment of burn patients with indomethacin may play a role in alleviating suppression of immune response in these patients.
A transverse Y-V advancement flap procedure for the closure of urethral fistulas is described. This simple and safe technical aid helps to provide a double-layer closure and is also helpful in preventing recurrence of the fistula.
Four patients with acute suppurative perichondritis were successfully treated with low dose X-ray irradiation. The infection had previously not responded to conservative management including incisional drainage and cartilage debridement.
Extreme flexion contracture of the knees due to extra-articular contracture of the knee joints is a frequent deformity in catastrophic neurological lesions such as multiple sclerosis, meningomyelocoele, paraplegia, quadriplegia, and cerebral spastic paralysis. Such gross knee contractures together with the coexisting hip flexion contractures create a severe nursing problem. Adequate perineal hygiene and positioning are very difficult to achieve and thus pressure sores frequently develop in these bed-ridden patients in spite of devoted nursing care. The orthopaedic surgeon can help alleviate the plight of these unfortunate victims: first the hip joint contractures are released by the classical methods and then, at the same session, the knee contractures: a simple one stage procedure is described. Primary cover of the large popliteal skin defect is achieved by a gastrocnemius versatile muscle flap, which is itself covered by a free split skin graft. An illustrative case is described.
Fifty-eight patients with keloid scars were subjected to combined cryosurgery and intralesional corticosteroid therapy. Complete regression of the scars occurred in 41 patients. In 8 patients the scars improved, and there was no improvement in 9 patients. Keloid scars of the earlobes were the most responsive to treatment. The possibility of differing biological activity of cryosurgery and corticosteroids complementing each other is postulated, and a combination of their respective actions may offer promise in treatment.
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Neurofibromatosis is a rare inherited disease that may present as facial hamartoma or as a more generalized disease with subcutaneous tumors, skin pigmentation in the form of café-au-lait patches, and multiple pedunculated neurofibromas on a narrow skin base. The generalized form of the disease is named after von Recklinghausen, who described its main features in 1882. In this paper, we restrict ourselves to a discussion of the craniofacial manifestation of the disorder and also report our experience in treating 2 patients with orbitofacial neurofibromatosis at the Rambam Medical Center in Haifa.
Various modifications have been made in the original McKissock design for breast reduction. These include limited areola elevation, a short inframammary incision, a narrow-based inferior vertical dermal flap, and deep coring out of all the remaining breast parenchyma. Reliance is placed on some sponotaneous skin shrinkage over the upper half of the breast following excision of breast tissue in depth. Consistently satisfactory results have attended routine use of this method-equally so when employed by surgeons in training.
A craniofacial malformation is caused by a developmental arrest that results in focal fetal dysplasia. The severity, location, and number of these dysplasias make a wide spectrum of abnormalities possible. In this spectrum nasal dysplasia and, more particularly, the malformations characterized by a cleft in the lateral part of the nose play a prominent role, but in past years they have received only scant attention. In Tessier's classification this nasoschizis is the Number 1 cleft. We present here our observation in 2 patients with nasoschizis and the procedure used to correct it. Both patients were operated on at the Rambam Medical Center in Haifa, Israel.
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Meralgia paresthetica is not well known in the plastic surgery literature, and consequently the diagnosis of this entity may be overlooked. In view of the frequency with which the groin flap is presently employed, the possibility of damage to the lateral femoral cutaneous nerve of the thigh should be borne in mind. In this paper the clinical picture as well as the anatomy and pathophysiology of this disorder are described.
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