Biomedical subjects

D Y Nakamura

Publications and source records attributed to D Y Nakamura.

6 recordsLinked to original sources

PubMed1999

Bowel preparation for flexible sigmoidoscopy: which method yields the best results?

BACKGROUND: Bowel preparation is a significant aspect of the flexible sigmoidoscopy procedure. Clear visibility of the bowel mucosa is critical for a thorough examination. The combination of a light breakfast in the morning and the application of 2 phosphate enemas a few hours before the examination is a safe and commonly used method of preparing a patient for a flexible sigmoidoscopy procedure. However, there is a paucity of objective data on the efficacy of this method of bowel preparation. It has been practiced on the basis of intuition and clinical experience. METHODS: In this prospective single-blinded randomized study, 429 consecutive patients were assigned to receive 1 of 4 different bowel preparations before elective 60-cm flexible sigmoidoscopy. After completion of the procedure, the examiner gave a subjective rating of the quality of the preparation. The rating was determined on the basis of the percentage of bowel mucosa that was visible. RESULTS: Statistical analysis of results suggests no significant difference in frequency of favorable ratings between the 4 bowel preparations. CONCLUSIONS: This study substantiates the practice of having a light breakfast and 2 phosphate enemas as a method of bowel preparation for a flexible sigmoidoscopy procedure. Additional preparatory measures such as dietary restrictions and ingestion of phospho-soda oral saline laxative did not significantly enhance the quality of the examination.

Cathartics↗

PubMed1992

Rating burn impairment.

We have described the method of rating impairment published by the American Medical Association (AMA) and the method requested by the Social Security Administration (SSA). For various reasons it will be some time before burn centers will be able to report impairment as easily as they now report length of stay and other parameters, but in time it will come. When it is possible, the methods used will probably not be identical with the AMA method nor the SSA method described previously. But whatever method is used, it will surely incorporate concepts from each and portions of each--and the two exist and are used right now. Therefore, it is useful for burn physicians to understand the two methods and be prepared to use either.

American Medical Association↗

PubMedDate not supplied

Treatment of fourth-degree hand burns.

Fourth-degree hand burns are rare but devastating injuries. They cannot be grafted readily but often require flaps and amputation, and impairment is significant. We report our 10-year experience (1981 to 1990) with deep hand burns to characterize our treatment and outcome. A total of 25 patients (35 hands) were treated. Eight local flaps, nine distant flaps, and two free-tissue transfers were performed. Eleven hands were treated with K-wire immobilization and grafting. Thirty-three amputations were done. Postburn function was evaluated in 25 salvaged hands. Eleven hands had good outcomes, whereas seven had moderate sequelae and seven were severely affected. Patients who were treated with flap coverage of exposed tendons and joints had better functional outcomes than those treated with delayed closure with immobilization and grafting. The excellent outcomes in the flap coverage group justifies the added commitment of technical and therapeutic resources that this treatment requires.

Adult↗

PubMedDate not supplied

Silipos neck wraps.

Burns of the neck are a problem. Grafted anterior necks can result in disfiguring hypertrophic scar contractures and wrinkling of the graft. The development of contractures can be prevented by effective splinting as soon as possible after the burn and by following a continuous wearing schedule until scar maturation is complete. Traditional neck conformers do not allow free neck rotation and can lead to stiffness as a result of decreased mobility. We used Silipos neck wraps for 10 patients who had good range of motion in the neck and who required pressure only for flattening of grafts and wrinkle prevention. The neck wrap is user-friendly, low in cost, and easy to fabricate and custom-fit for individual patients.

Bandages↗

PubMedDate not supplied

The use of the Millard "crane" flap for deep hand burns with exposed tendons and joints.

Deep hand burns with exposed tendons and joints are rare but devastating injuries. They cannot be grafted and require flaps. Abdominal or groin flaps are commonly used, but they are bulky and require separation of the digits. We tried the Millard "crane" flap for these burns and compared our patients' results with those of patients who had received standard abdominal skin flaps. Eleven deep hand burns that had been treated with flaps were evaluated. Six patients had been treated with the crane flap and 5 had been treated with conventional abdominal skin flaps. All crane procedures provided graftable wound beds. The total active ranges of motion of all 11 patients 6 months after the surgical procedures showed no statistical difference. The crane method also provides good cosmetic results. None of the hands treated with crane flaps required procedures to separate the digits or debulk the flaps, but all of the hands treated with conventional abdominal skin flaps required these types of procedures.

Abdomen↗

PubMedDate not supplied

The Unna 'sleeve': an effective postoperative dressing for pediatric arm burns.

The goal of this study was to develop a postoperative plan for sheet grafts that would protect the graft, yet would also eliminate the need for daily wound care. Eleven pediatric patients (13 arms burns) who underwent excision and grafting were included in our study. The total area on the arm ranged from 1% to 5% total body surface area. All grafts were sheet grafts held in place with steri-strips or sutures. The grafts were covered with a layer of greasy gauze, followed by an Unna done paste dressing, and then an elastic bandage. The Unna "sleeve" remained in place for an average of 6 days (range, 3 to 10 days). In eight cases, a second Unna sleeve was applied and removed 6 to 7 days later. In all 13 cases, additional wound care for grafts was unnecessary, and patients did not require extended inpatient hospitalization. Graft take was 100% in all cases, and no reconstruction was required.

Arm Injuries↗