Biomedical subjects
Publications and source records attributed to D Mahler.
Although few women sustain thermal injuries during pregnancy, when pregnancy is complicated by thermal injury a clear management scheme plus a team approach is needed to provide optimal care both to the foetus and mother. The clinical course of eight pregnant women treated in our burn unit is presented. The relationship between the burn area, gestational age at treatment and prognosis is analysed. Active surgical treatment is advocated.
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A chemically treated bovine skin, Dermodress, is presented as a new type of biological dressing for exposed tendons, bones, and nerves following extensive thermal or severe soft-tissue injuries to the hand. Its use enables the surgeon to postpone closure of defects with grafts or flaps until the presence of healthy, viable tissue is secured. The vital structures underneath the covering are kept moist, thus preventing necrosis and desiccation. Because of its adherence properties, Dermodress use also allows early mobilization and bathing, thereby accelerating rapid return of function.
Our experience with early tangential excision and grafting for burns of the hands is presented. The advantages of the early surgical approach are proven by comparing this technique with the 'old' conservative treatment in two different populations. It is clearly concluded that early excision and grafting, combined with adequate physiotherapy and pressure garments, offer favourable results for the burned hand. Early excision of the burn eschar, before the appearance of contamination, may prevent infection, long and unfavourable delay in healing, scar formation with its incapacitating sequellae and a non-aesthetic appearance. Such a delay was characteristic of the 'conservative period', which was dominated by 'fibroblast', 'good granulation tissue', and hypertrophic scarring. Early surgery, as described and advocated here, shortens the healing time, lessens the hospital stay, minimizes reconstructive surgery and leads to a good functioning hand with a reasonable aesthetic appearance, enabling the affected patient to return quickly to work and normal routine life.
Splinting in burns is by no means a new subject, but this paper tries to demonstrate a new approach using new materials and sometimes humour. Conventional burn splints, dynamic and static, have been described in the past. All the following splints are made either with Mediplast, a new Israeli product, or Hexcelite.
A rare case of dermatofibrosarcoma protuberans on the face of a 10-year-old boy is presented. The patient's young age and the localization of the tumor led to limited excisions that resulted in two local recurrences. Primary wide excision with 2.5 cm of free margins is recommended to avoid local recurrences that are otherwise frequent.
The prominent ear was first noted in the medical literature to be a social and psychological disturbance in 1881, when Ely suggested the first technique for the correction of this condition. Since Ely many surgeons have tried to find the best solution for this deformity; however, because of the specific cartilagenous architecture of the auricle, no one has yet designed an acceptable and secure technique. The successful reconstructured auricle should be the result of tackling all components of the deformity, namely, the absence of the antihelix and the aloofing of the concha from the mastoid. Mustarde's technique and the various anterior scoring methods do not deal with the conchal component of the protruded ear, nor do they give a fully satisfactory formation of the antihelix when one of these methods is used alone. This article presents the author's preferred technique for reconstructing the auricle, simultaneously using Mustarde's mattress sutures, Cochrane's anterior scoring of the antihelix, and the approximating of the concha to the mastoid.
The author suggests a method to protect the skin of the nose from vascular impairment, bruising, necrosis, and other complications by interposing between the nasal skin and the overlying splint or cast a protective layer of a soft delicate material such as Telfa or Scrylin.
"Dermodress" is a new temporary biological dressing (heterograft) composed of a pure neonatal bovine collagen I. The authors present their first trial with this skin substitute. Ten consecutive patients who required skin grafts were included in the pilot test group. The "Dermodress" was tested on their donor sites and compared with "Furacin" gauze. It was found that "Dermodress" provided a covering that adhered excellently to debrided surfaces, without disturbing the healing processes underneath, for up to three weeks after application. The results point to the potential value of the "Dermodress" for open wounds.
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Turbinectomy, in cases of inferior or middle turbinate hypertrophy, is one of the solutions for nasal breathing difficulties. For many decades, this procedure was controversial owing to the severe complications believed to occur after such an operation. Its performance was held to be within the responsibility of otolaryngologists. However, eventually most of these complications were found to be nonexistent, and the performance of turbinectomy became a simple surgical procedure. The turbinate hypertrophy, which often exists on the contralateral side of the deviated septum, blocks the correct reposition of the septum with the consequent nasal bone, and thus prevents the plastic surgeon from achieving a straight nose. Therefore, proper handling of both septal deviation and turbinate hypertrophy is an important aid for the plastic surgeon. This article is dealing with the various aspects of turbinate hypertrophy and its surgical handling.
Our experience with infrequent and unfamiliar types of injury caused by various compounds of bromine are described and discussed. While bromine containing compounds share some of the characteristics of other common causes of chemical burns, they also have a specific, exclusive mode of affecting the skin. The delay in the appearance of clinical signs and symptoms is an important factor to be considered by those who treat injuries caused by bromine or some of its compounds, or by those who may be the first to see persons who are injured by these agents. As most of the injuries occur at work (92 per cent) it is in these industrial premises that considerable stress should be made of the importance of wearing protective clothing in order to reduce local damage and prevent systemic effects. Prompt first aid, by thorough washing with large volumes of water reduces the extent and depth of the injury.
A chemically treated bovine skin, Dermodress, is presented as a long-term skin substitute. Dermodress was applied over denuded surfaces of debrided deep burns and was kept in place for up to 56 days. Dermodress adheres to all contours of the debrided surfaces, has hemostatic effect and does not present any signs of infection or rejection. Dermodress can be removed in stages according to the availability of autografts, which may be applied immediately, since the exposed areas are clean and suitable for immediate grafting. Our clinical experience shows that Dermodress has most of the required properties of a long-term temporary skin substitute.
Follow-up observations are presented of a set of quintuplets at 5 years of age. Three of the children were born with different degrees of oral clefting. Height and weight comparisons between siblings with clefts and those without reveal that the most severely affected children lagged in their height measurements at the age of 5 years. This may indicate need for special awareness when caring for such children. A relative constriction of the anterior segment of the maxillary dental arch in two of the affected siblings may reflect a possible effect from previous surgical intervention.
Because right ventricular ejection fraction (RVEF) depends on impedance to RV ejection, the hypothesis was tested that an abnormality in radionuclide-determined RVEF would be a useful noninvasive predictor of pulmonary artery (PA) hypertension in patients with chronic obstructive pulmonary disease (COPD). Simultaneous measurements of resting RVEF and PA pressure were made in 30 patients with COPD. All were stable and without clinical evidence of respiratory decompensation or congestive heart failure. Eleven patients had normal (less than 20 mm Hg) mean PA pressure and 19 patients had PA hypertension. The average RVEF was 41 +/- 7% (range 29 to 60%). Five patients had normal (greater than 45%) and 25 patients depressed RVEF. An inverse linear relation between mean PA pressure and RVEF was present (r = -0.74). In the group with normal PA pressure, RVEF averaged 48% (range 42 to 60%). In the group with PA hypertension, RVEF averaged 36% (range 29 to 44%). RVEF was significantly higher in the group with PA hypertension. Using RVEF less than 45% as an indicator of PA hypertension, the sensitivity was 100%, the specificity 55%, and the predictive accuracy of a positive result 79%. Using RVEF less than or equal to 40% as an indicator of PA hypertension, the sensitivity was 75%, the specificity 100%, and the predictive accuracy of a positive study 100%. Thus, radionuclide-determined RVEF using the first-pass technique and a multicrystal camera is a useful noninvasive test for diagnosing PA hypertension in patients with advanced COPD.
Thirty-four female patients who underwent rhinoplasty were followed through assessment of post-surgical satisfaction (pss), perception of subjective improvement, objective improvement (surgeon's ratings), and objective post-surgical nasal deformity. Assessments of pss and subjective improvement were obtained on 3 occasions: T1, 1 week after surgery, on cast removal; T2, 1 month after cast removal; and T3, 3 months after cast removal. The investigation was aimed at examination of the relationship of patients' subjective post-surgical appraisals of the operation with objective indices of outcome of rhinoplasty. Results indicated that at T1, pss is totally dissociated from objective outcome or its appraisal by the patient. At T2 an association between objective outcome and pss and subjective appraisal of outcome is evident, but seems to reflect the total reliance of the patients' judgment on surgeons' appraisals. At T3 a paradoxical trend is indicated: slim objective favorable outcomes correlate with high pss, while a considerable share of patients with whom a highly favorable outcome has been attained express relatively low pss. This paradoxical trend may be well understood when applying Cognitive Dissonance Theory. The whole pattern of results point again at highly complex and powerful psychological processes, some of them seemingly irrational, operating within patients when relating to rhinoplasty, a simple superficial surgical procedure.
Clinical and pathological aspects of an unusual case of bilateral, multiple glandular cysts of the nasal mucosa, originating from both inferior turbinates, are herewith described, as an occasional finding in rhinoplasty. Although cystic structures are common in the upper respiratory tract, the development of a mucous cyst in the nasal cavity is a very rare occurrence. The differential diagnosis of nasal glandular cysts from other cystic conditions appearing in the nasal cavity is discussed.