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Biomedical subjects

D Sutton

Publications and source records attributed to D Sutton.

171 records · Page 10Linked to original sources
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Muscle transposition in the rehabilitation of the paralyzed larynx.

Muscle transposition of the innervated omohyoid muscle into the tendon of the paralyzed posterior cricoarytenoid muscle was studied in a small series of subhuman primates. A similar procedure was described previously by King for treatment of bilateral recurrent nerve injuries. Our studies confirm that this procedure adequately enlarges the airway to allow normal activity without a tracheostomy. Histologic studies appear to show nerve ingrowth occurring at 6 months as in other neuromuscular pedicle procedures. The procedure is easily performed and causes no other muscle denervation.

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Wound tension and blood flow in skin flaps.

The relationship between wound-closing tension, blood flow, and flap viability is examined using piglets as an experimental model. Twenty-seven rectangular skin flaps with random-pattern blood flow were created and closed under varying tensions. Closing tensions were accurately measured using a stabilized mechanical force gauge. In flaps with an impaired blood supply, there was a statistically significant increase in flap necrosis for those flaps closed with greater than 250 g of tension. The laser Doppler demonstrated a clear-cut inverse relationship between flap tension and blood flow in these flaps which correlated well with the experimental flap necrosis seen.

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Contralaterally elicited electrical stimulation of paralyzed facial muscles.

Functional electrical stimulation is being explored in the extremities. A major obstacle is found in programming the firing sequence. In 1976, David Zealear proposed using the activity on the normal side in axial muscle pairs that normally function symmetrically to act as a template to control the stimulator. This method was demonstrated in laryngeal muscles in dogs, and is now demonstrated in the face with future applications being proposed. The facial nerve on one side was sectioned in a series of rabbits. Implanted electrodes received electrical potentials from selected muscles on the normal side. Bursts of electrical activity on the normal side during a blink or a twitch were used to trigger a muscle stimulator, which was routed to matching muscles on the paralyzed side. This technique restored symmetric function to the hemiparalyzed side. This technique restored symmetric function to the hemiparalyzed face.

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Delayed reinnervation of unilateral vocal cord paralysis in dogs.

The neuromuscular implantation technique for rehabilitation of unilateral vocal cord paralysis was performed in four dogs at the time of denervation and in six dogs after varying intervals of chronic denervation. As would be expected, the chronically denervated animals did not achieve the vocal cord excursion of the acute denervations, but some return of motion was noted even after six months. Histologic examination of the posterior cricoarytenoid muscle was correlated with the return of movement.

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Taming the supplies and inventory process at Westmead Hospital.

UNLABELLED: In July 1991, a team within the Clinical Chemistry Department at Westmead Hospital used control charts and other statistical tools to analyze the supplies and inventory process. No single major problem was discovered. Instead, the team found many small problems causing delays and inefficiencies in the process. By developing and implementing multiple solutions, the team was able to streamline the process and reduce the number of principal suppliers. RESULTS: The number of principal suppliers was reduced by two-thirds. The average number of "urgent" orders, which add extra steps to the purchasing process, was reduced by three-quarters. The mean turnaround time for common clinical chemistry laboratory tests improved by 8%.

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The haemodynamic effects of percutaneous transluminal angioplasty.

The aim of the study was to measure the haemodynamic effect of percutaneous transluminal angioplasty (PTA). Twenty-one consecutive patients with unilateral stenosis of the iliac (n = 13) or femoropopliteal arteries (n = 8) causing intermittent claudication were studied with ankle and brachial systolic pressure measurements before and after PTA and at six monthly intervals. In 15 patients, the pressures were measured not only at rest, but after exercise on a standard treadmill. There were six technical failures. All of the remaining patients were improved clinically and objectively. The resting pressure index increased from mean (+/- ISD) of 0.65 +/- 0.22 to 0.88 +/- 0.17 and the postexercise index from 0.43 +/- 0.21 to 0.82 +/- 0.22. The preoperative claudication distance was improved from 83 m +/- 31 to 252 m +/- 104 and the recovery time from 6.3 mins +/- 5.7 to 1.5 mins +/- 2.3. During the follow up period of six weeks to 2 1/2 years, the initial improvement was maintained and there were no failures clinically or on further Doppler examination. The results suggest that for patient with a single significant stenosis, PTA is an effective alternative method of treating claudication.

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