Biomedical subjects

D B Drake

Publications and source records attributed to D B Drake.

At least 37 records · Page 2Linked to original sources

PubMed1996

Effect of puncture resistant surgical gloves, finger guards, and glove liners on cutaneous sensibility and surgical psychomotor skills.

New puncture and cut resistant hand protection systems have been developed to enhance the barrier to cuts and needle puncture injuries during surgical procedures. It is important, however, that these new hand protection systems do not reduce tactile sensitivity or dexterity during surgery. Consequently, it was the purpose of this report to compare the cutaneous sensibility and dexterity of physicians' hands covered by these new puncture and cut resistant hand protection systems to that of the standard surgical latex glove. The hide (Medak) portion of the Life Liner and the polyethylene (Spectra) portion of the FingGuard, which offered the greatest resistance to needle puncture, were associated with the greatest reduction in cutaneous sensibility, as determined by moving and static two-point discrimination, aesthesiometer pressure sensation, and discrimination of suture size and configuration. In addition, the physicians believed that the puncture and cut resistant Life Liner glove liner markedly interfered with their handling of surgical instruments. The ultimate benefit of these puncture and cut resistant hand protection systems must be determined in well-controlled clinical trials.

Discrimination, Psychological↗

PubMed1995

New instruments, bone liners, and tray for finger joint arthroplasty.

Titanium circumferential grommets have been developed for finger joint arthroplasty that fit on the base of the silicone implant stems to protect the flexible hinge from tearing and fracture. To facilitate grommet insertion, new intramedullary bone rasps have been devised with a reverse cutting tooth pattern, an extended shaft for an improved view of the surgical field, and a redesigned cutting head to allow for grommet insertion. Surgical accessibility and ease of recognition have been facilitated by the development of color-coded sizers. All of the instruments necessary for finger joint surgery are available in a molded tray that has also been redesigned with a transparent lid and clearly labeled compartments for accurate determination of instruments and implant sizers.

Equipment Design↗

PubMed1995

An overview of first metatarsophalangeal joint implant arthroplasty.

The metatarsophalangeal joint of the great toe often requires an arthroplasty to correct joint disease and pain. Today, joint replacement systems are combinations of components manufactured to optimize biological ingrowth, mechanical interlock, press fit, and cementing. Three different types of arthroplasties are available to foot surgeons: the double stem hinged silicone implant, the two-component joint mimicking implant, and a hemi-implant available for the phalanx. No comprehensive studies on very large populations have been conducted to accurately evaluate the beneficial long-term effects of these implants. This review article describes the development of the toe arthroplasty, details the commercially available implants, and addresses the advantages and adverse effects of each implant.

Humans↗

PubMed1995

Reconstruction for limb-sparing procedures in soft-tissue sarcomas of the extremities.

An understanding of the biology of soft-tissue sarcomas and knowledge of refined techniques of adjuvant therapy have allowed limb-sparing procedures to become predominant in the management of these tumors. Immediate bony reconstruction with prosthetic implantation has met with consistent success largely because of the vascularized coverage provided by local and distant flaps. Microvascular reconstruction allows wound closure with vascularized tissue in one stage. The use of a distant donor site does not alter the function of an already compromised limb as would a local muscle flap, and, in selected cases, the transplant may augment the functional ability of the limb. The use of a distant site also does not require extensive dissection in regional tissue planes, which theoretically could spread the local disease.

Biopsy↗

PubMed1995

Wound healing considerations in chemotherapy and radiation therapy.

Adjunctive radiation and chemotherapy have evolved to increase the survival rates and disease-free intervals that can be accomplished with surgical resection. We have reviewed the salient effects these agents have on wound healing. Further investigations into the specific wound-healing deficits caused by these agents and the development of interventional therapies will enable us to manipulate the wound milieu in order to accomplish the goal of oncologic cytoreductive therapy without detrimental effects on wound healing.

Brachytherapy↗

PubMed1994

Magnetic resonance imaging of in situ mammary prostheses.

A study was conducted at the University of Virginia Health Sciences Center to examine the effectiveness of magnetic resonance imaging in detecting rupture or deflation of in situ mammary prostheses. Thirty-three women with 59 prostheses were included in the study. Fifteen of the 33 patients had undergone surgery for removal or replacement of 21 implants. Positive findings for rupture were accurately predicted for 15 implants and confirmed at surgery. Negative findings for rupture were accurately predicted in the remaining 6 implants and confirmed at surgery. Although it is a more costly procedure than either mammography or ultrasonography, we believe that magnetic resonance imaging is also more accurate in detecting damaged implants, particularly when they are contained within an intact capsule or when the implants are stacked. Unlike mammography, magnetic resonance imaging requires no ionizing radiation or breast compression. Magnetic resonance imaging of the in situ breast prosthesis may be a useful adjunct when other modalities yield inconclusive results or when a contained rupture is suspected.

Adolescent↗

PubMed1993

Calvarial deformity regeneration following subtotal craniectomy for craniosynostosis: a case report and theoretical implications.

We describe an infant with combined sagittal and unilateral coronal synostosis who underwent "total vault" craniectomy for skull reshaping. The operative procedure was interrupted without replacement of the calvarial bone grafts. Follow-up over the ensuing 2 months revealed regeneration of the entire cranium and supraorbital rims, as well as (in contrast to earlier reports) redevelopment of fusion within the suture at the same site noted in the initial operation, associated with similar skull deformity. These observations are reviewed with special emphasis on the theoretical implications for the etiology of craniosynostosis and skull deformity.

Bone Regeneration↗

PubMed1992

Shave excision and dermabrasion for facial angiofibroma in tuberous sclerosis.

Tuberous sclerosis is an inheritable disease of varied manifestations. Hallmarks of the disease have historically been identified as infantile seizures, severe mental retardation, and facial growths. The facial lesions were formerly termed adenoma sebaceum, but are now known to be angiofibroma. We present a patient who was referred for management of large facial lesions complicated by intermittent hemorrhage. A combination of shave excision and dermabrasion led to a symptomatic and cosmetic improvement.

Adult↗

PubMed1992

Digital sympathectomy for refractory Raynaud's phenomenon in an adolescent.

We describe the case of an adolescent with severe Raynaud's phenomenon refractory to conventional medical management. Her course was complicated by fingertip ulceration and necrosis. The localized surgical technique of digital sympathectomy was successfully used in the management of her disease, and should be considered for intractable Raynaud's phenomenon.

Adolescent↗

PubMed1987

Coloanal anastomosis in the management of benign and malignant rectal disease.

The aim was to determine the efficacy, safety, and long-term clinical and functional results of coloanal anastomosis in patients with complicated benign and malignant rectal disease. Twenty-nine patients underwent coloanal or colopouch-anal anastomosis for either carcinoma of the rectum not technically amenable to conventional low anterior resection, severe radiation injury, large benign lower third tumors, or complications of previous operations. The mean age of the patients was 61 years and 82% were men. A diverting colostomy was constructed in 55% of the patients. The mean (+/- SEM) length of follow-up was 20 +/- 3 months. There was no operative mortality. Transient urinary retention, however, occurred in 40%, anastomotic stricture in 28%, and anastomotic leakage in 3.4%. Four patients (14%) could not have intestinal continuity restored and therefore were considered failures. The stool frequency for all remaining patients (N = 25) was 3 +/- 1 per day (mean +/- SEM) and did not vary with age, sex, or indication for operation. Complete continence was achieved by 84% of patients, but no patient was incapacitated by poor bowel function. In patients in whom a conventional colorectostomy is impractical or unwise, coloanal anastomosis is a safe and efficacious alternative operation that preserves anal continence.

Adenocarcinoma↗

PubMedDate not supplied

Grease burns of the hand: preventable injuries.

Grease burns to the hand represent a serious and preventable hazard. These injuries account for over 10% of all major burns seen in the emergency department. These burns occur when the cook attempts to move a pan with burning cooking oil and inadvertently spills the oil on the hand holding the pan. These burns are usually full thickness because of either the high temperatures of the flaming oils or the subsequent ignition of clothing. This article describes a patient who received severe partial and full thickness burns to the dominant hand following a grease burn in the domestic setting. Prevention through improved consumer education and warning labels for cooking oils should reduce the incidence of these serious injuries.

Accidents, Home↗

PubMedDate not supplied

Steam press hand burns: a serious burn injury.

Steam presses cause full-thickness burns when the operator's extremity is caught between the buck and the head of the steam press. Patients with serious steam press burns should be referred to a regional burn center for excision of the full-thickness burn and coverage by either a split-thickness skin graft or a flap. The safety features in steam presses that could prevent this serious injury include: (1) emergency safety releases, (2) peripheral safety bars, and (3) two-hand operator control.

Accidents, Occupational↗

PubMedDate not supplied

Natural rubber latex allergy: spectrum, diagnostic approach, and therapy.

Latex allergy has reached epidemic proportions in the United States and is increasingly recognized as a significant contributor to morbidity and mortality during medical and surgical procedures. Ultimately, many of the affected patients with recognized latex sensitivity and those who are not yet diagnosed will receive treatment for their allergic reactions to latex in emergency departments. Consequently, emergency physicians must have a comprehensive understanding of the etiology, epidemiology, pathogenesis, treatment, and management of these challenging patients. Groups at high risk include spina bifida cystica patients, health care workers, latex industry workers, specific food-allergy patients, and patients with a history of atopy or multiple surgical procedures. Sensitization to latex antigens is commonly encountered in health care workers wearing latex gloves with high latex allergen concentrations and in workers using powdered latex surgical gloves. Exposure to air-borne allergens and water-soluble IgE reactive latex antigens from natural rubber latex products in sensitized individuals can result in type I (immediate) hypersensitivity reactions. Clinical manifestations include contact urticaria, dermatitis, allergic rhinitis, conjunctivitis, asthma, angioedema, and anaphylaxis. Diagnostic tools include serological assays and skin prick testing. At present, latex avoidance is the only available treatment and is the key to preventing allergic reactions in latex-sensitized individuals. Health care worker sensitization to latex antigens in natural rubber products is becoming an increasing contributor to workers' liability and disability claims. Specific action can be taken to reduce occupational and patient exposure to latex antigens.

Anaphylaxis↗

PubMedDate not supplied

Industrial high-voltage electrical burn of the skull, a preventable injury.

Deep burns of the scalp and skull are often caused by high-voltage electrical injuries. Patients with such injuries should be referred to regional burn centers that are prepared to excise necrotic burn tissue and cover the devitalized bone with a well-vascularized flap. Strategies for prevention of these electrical burns are discussed.

Accidents, Occupational↗

PubMedDate not supplied

Technical considerations in knot construction. Part I. Continuous percutaneous and dermal suture closure.

The purpose of this investigation was to determine the security of the square knot tied with one looped end and one free end versus the security of the square knot tied with two free ends. Size 4/0 and size 6/0 monofilament nylon, polypropylene, and Biosyn sutures were selected for this evaluation. The mechanical performance of these sutures was judged according to knot breakage force and number of throws required to attain security. Knots with one looped end and one free end require more throws to ensure knot security than do knots constructed from two single suture strands of comparable sizes and types of sutures.

Caprolactam↗

PubMedDate not supplied

Search for a scientific basis for continuous suture closure: a 30-yr odyssey.

Continuous percutaneous and dermal suture closures have an important role in the approximation of long, linear lacerations in the emergency department. This report documents the scientific basis for these continuous closure techniques. In addition, a detailed description of these surgical closure techniques is presented.

Evidence-Based Medicine↗

PubMedDate not supplied

Metacarpophalangeal joint dislocation: indications for open surgical reduction.

In complex dislocations of the metacarpophalangeal joint, the volar plate is separated from the proximal phalanx and the metacarpal head is entrapped within surrounding tissue structures. These complex dislocations must be managed by open surgical reduction to reduce the dislocation and realign the volar plate. A 58-year-old male presented to the emergency department with a complex dislocation of the metacarpophalangeal joint of the left little finger, which was successfully treated by open reduction in the operating room. The indications for open reduction of metacarpophalangeal joint dislocations are reviewed.

Collateral Ligaments↗

PubMedDate not supplied

Molten metal burns: further evidence of industrial foundries' failure to comply with Occupational Safety and Health Administration regulations.

The purpose of this report is to describe another case of a molten metal burn to the foot of a foundry worker. The foundry in which he worked failed to comply with Occupational Safety and Health Administration regulations with regard to protective apparel. This injury could have been prevented with annual, unscheduled inspections by the Occupational Safety and Health Administration and with enforcement of additional regulations regarding protective apparel.

Accidents, Occupational↗