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Biomedical subjects

L N Hurst

Publications and source records attributed to L N Hurst.

At least 19 recordsLinked to original sources
PubMed2000

Breast-feeding after inferior pedicle reduction mammaplasty.

The breast-feeding practices of a series of postpartum women, who had undergone prior reduction mammaplasty by means of an inferior pedicle approach, are reported in this retrospective study. Also identified are the factors that influenced the decision to breast-feed postoperatively. From a patient pool of 544 individuals who elected to have reduction mammaplasty between 1984 and 1994 (age range, 15 to 35 years), 334 could be contacted and interviewed by means of telephone by using a standardized questionnaire. Successful breast-feeding was defined as the ability to feed for a duration equal to or greater than 2 weeks. Seventy-eight patients had children after their breast reduction surgery. Fifteen of the 78 patients (19.2 percent) breast-fed exclusively, 8 (10.3 percent) breast-fed with formula supplementation, 14 (17.9 percent) had an unsuccessful breast-feeding attempt, and 41 (52.6 percent) did not attempt breast-feeding. Of the 41 patients not attempting to breast-feed, 9 patients did so as a direct consequence of discouragement by a health care professional. Further reasons for feeding with supplementation, having an unsuccessful attempt, and not attempting to breast-feed are presented. Of the 78 women who had children postoperatively, a total of 27 were discouraged from breast-feeding by medical professionals with only 8 of the 27 (29.6 percent) subsequently attempting, despite this recommendation. In comparison, 26 patients were encouraged to breast-feed; nineteen (73.1 percent) of them did subsequently attempt breast-feeding. This rate is statistically significant by using a chi2 test with 1 df(p = 0.0016). Postpartum breast engorgement and lactation was experienced by 31 of the 41 patients not attempting to breast-feed. Of these 31 patients, 19 believed that they would have been able to breast-feed due to the extent of breast engorgement and lactation experienced. Given the use of an inferior flap mammaplasty technique and patient encouragement, the possibility for breast-feeding after reduction mammaplasty exists. This prevalence falls near the breast-feeding rate found in the population not having undergone breast surgery, according to an article in the Canadian Journal of Public Health.

Adolescent↗
PubMed1999

Reduction mammaplasty improves breast sensibility.

The belief that breast hypesthesia is an expected consequence of reduction mammaplasty is based on past reports that failed to objectively quantify breast sensibility. Forty-five women undergoing reduction mammaplasty by one plastic surgeon using a single operative technique were followed prospectively for change in breast sensation. Pressure threshold measurements were taken preoperatively and at 2 and 6 weeks postoperatively, by using Semmes-Weinstein monofilaments. Areas tested included the nipple, four points on the areola, and four points 1 cm from the areola on the breast skin. The data were nonparametric and were analyzed by using the Wilcoxon signed rank test. For all areas tested, sensation significantly improved from preoperatively to 2 weeks (i.e., nipple: 33.1 versus 29.3, p<0.0004) and again from 2 to 6 weeks (i.e., nipple: 29.3 versus 19.3, p<0.002). Relief of chronic nerve traction injury is conjectured as the reason for sensibility improvement. Numb nipples persisted in 2 percent of breasts at 6 weeks.

Adult↗
PubMed1996

Single-portal endoscopic carpal tunnel release: agee carpal tunnel release system.

This single-group prospective cohort study was conducted to define the efficacy and safety of single-portal endoscopic carpal tunnel release using the redesigned carpal tunnel release system (3M Healthcare, St Paul, MN). Eighty-six procedures in 69 patients were evaluated by objective motor/sensory testing and clinical outcome questionnaire at 10 days, and 6 and 10 weeks postoperatively. All cases were performed by the same surgeon using a similar local anesthetic technique. The subjective symptoms of carpal tunnel syndrome, including paresthesia, numbness, and pain, demonstrated substantial improvement by 10 days postoperatively, and less than 2% of the subjects remained symptomatic by 10 weeks. The percentage of patients with normal, static, two-point discrimination in the median nerve distribution, demonstrated significant improvement by 6 weeks postoperatively. Preoperative grip and three-point pinch strength were regained by 6 weeks postoperatively, while lateral pinch demonstrated substantial improvement in the same time period. Workers' compensation cases required a significantly longer time to return to work (mean, 40.8 days) than nonworkers' compensation cases (mean, 22.2 days). No difference, however, was demonstrated between workers' compensation and nonworkers' compensation cases with respect to the time of return to activities of daily living (mean, 13.5 days). There were no major neurovascular injuries incurred during the performance of the study. The most important complications included one mild reflex sympathetic dystrophy, three transient digital neuropraxias, and one superficial wound infection. In conclusion, the performance of single-portal endoscopic carpal tunnel release using the redesigned Agee carpal tunnel release system is both a safe and efficacious procedure.

Activities of Daily Living↗
PubMed1996

High frequency 40-MHz ultrasound. A possible noninvasive method for the assessment of the boundary of basal cell carcinomas.

BACKGROUND: Ultrasound imaging systems operating close to 20 MHz in frequency have been used to image skin tumors. Ultrasound imaging at 20 MHz has been used to determine the boundaries of basal cell carcinomas (BCCs). An inherent shortcoming of imaging systems operating at these frequencies is their limited resolution. OBJECTIVE: We investigated whether 40-MHz ultrasound imaging could provide higher resolution compared with the lower frequency systems and thus be a superior, noninvasive method of assessing the boundaries of BCCs. METHODS: Nine BCCs from six individuals were examined clinically and ultrasonographically, and then biopsied to confirm diagnosis. The depth of BCCs measured on histological sections was compared with the corresponding value obtained using ultrasound. For this study we required a nonsurgical, nondestructive means of treating BCCs that would allow repeated ultrasound imaging, and therefore topical 5-flurouracil (5-FU) was chosen. Following 5-FU therapy a biopsy was obtained from the site of the treated BCC after ultrasound imaging had been performed. Clinical, ultrasonic and histopathologic evaluation of each BCC was carried out independently by different individuals. At the end of the study all the BCC sites were treated surgically be electrodesiccation and curettage or completely excised. RESULTS: High resolution ultrasound images of BCCs were obtained with agreement between histology and ultrasound findings in all none lesions prior to therapy and in eight of none lesions posttherapy. There was a significant correlation between the depth of BCCs measured histologically and using ultrasound (P = 0.0004, r = 0.92). CONCLUSIONS: This study suggests that 40-MHz ultrasound may provide an estimate of the boundary of a BCC in vivo. High frequency 40-MHz ultrasound imaging may be an adjunct to clinical and histologic evaluation but does not replace the need to obtain tissue for microscopic examination.

Aged↗
PubMed1995

Intralesional methotrexate in keratoacanthoma of the nose.

Keratoacanthomas are rapidly growing benign cutaneous neoplasms, usually occurring on sun-exposed areas of the body. Although many treatment modalities have been described, surgical excision is currently the treatment of choice for the majority of keratoacanthomas. Occasionally, however, the size and location of these lesions preclude complete excision without extensive reconstruction and/or scarring. Two such cases of large keratoacanthoma of the nose were treated successfully with intralesional methotrexate. The rapid regression and very acceptable final cosmetic result suggest that intralesional methotrexate may play a beneficial role in the treatment of these difficult lesions and encourage further study of the benefits of this treatment modality.

Aged↗
PubMed1992

Plantar fibromatosis and bilateral flexion contractures: a review of the literature.

Plantar fibromatosis is a benign multinodular lesion occurring in the plantar fascia. It is generally an asymptomatic lesion or may occasionally cause discomfort or pain in the foot. We present a man who has bilateral flexion contractures of his great toes as a result of his plantar fibromatosis. A review of the literature indicates that this is a very rare presentation of plantar fibromatosis.

Aged↗
PubMed1991

The effects of early postoperative radiation on vascularized bone grafts.

The effects of early postoperative radiation were assessed in free nonvascularized and free vascularized rib grafts in the canine model. The mandibles of one-half of the dogs were exposed to a cobalt 60 radiation dose of 4080 cGy over a 4-week period, starting 2 weeks postoperatively. The patency of vascularized grafts was confirmed with bone scintigraphy. Histological studies, including ultraviolet microscopy with trifluorochrome labeling, and histomorphometric analyses were performed. Osteocytes persist within the cortex of the vascularized nonradiated grafts to a much greater extent than in nonvascularized, nonradiated grafts. Cortical osteocytes do not persist in either vascularized or nonvascularized grafts subjected to radiation. New bone formation is significantly retarded in radiated grafts compared with nonradiated grafts. Periosteum and endosteum remained viable in the radiated vascularized grafts, producing both bone union and increased bone turnover, neither of which were evident to any significant extent in nonvascularized grafts. Bone union was achieved in vascularized and non-vascularized nonradiated bone. In the radiated group of dogs, union was only seen in the vascularized bone grafts.

Animals↗
PubMed1986

The temporalis myo-osseous flap: an experimental study.

The present paper investigates the anatomy and vascularization of the temporalis myo-osseous flap. This is a calvarial bone flap that employs temporalis muscle and its distal pericranial extension as a pedicle. In six human cadavers the flap was raised as an island on the anterior deep temporal artery after transecting the zygomatic arch and coronoid process. Maximal mobilization was thus obtained, allowing rotation of the flap into the mouth for intraoral reconstruction. The arc of rotation and potential surgical applications were noted. A comparative study of the temporalis myo-osseous flap and free calvarial bone graft was then conducted in a rabbit model. Vascularization of the calvarial bone flap was confirmed by technetium scintigraphy performed on the first postoperative day. The uptake of fluorochrome labels immediately after transfer verified the adequacy of the periosteal circulation in maintaining viability and new osteoid formation throughout the full thickness of calvarial bone. The transplantation of free calvarial bone grafts was followed by necrosis of most cellular elements. This was demonstrated by an absence of fluorochrome uptake up to 19 days postoperatively and a predominance of empty lacunae and nonviable marrow.

Animals↗
PubMed1986

Arteriovenous fistulas after replantation surgery.

The delayed appearance of congenital arteriovenous fistula precipitated by local trauma is a rare event. However, these reports may provide some insight into pathogenetic mechanisms responsible for the opening of subclinical arteriovenous communications. This case of multiple arteriovenous fistulas in a previously "normal" hand followed a sharp, incomplete amputation at the wrist level with replantation.

Amputation, Traumatic↗
PubMed1986

The salvage of infected cardiac pacemaker pockets using a closed irrigation system.

Over a period of 71 months, 19 patients were treated for infected or eroded permanent pacemaker pockets. All cases were treated with local debridement and insertion of a closed irrigation system using a solution of tyloxapol and tobramycin. Successful eradicaiton of the infection, without complete replacement of the pacemaker system, was achieved in all cases.

Aged↗
PubMed1984

Prolonged life and improved quality for stored skin grafts.

This study is presented as both a follow-up and an extension of previous work on storage techniques for the preservation of skin by refrigeration. Rabbit skin grafts were used to compare the merits of various storage media. One of the media, McCoy's 5A plus serum, gave improved skin graft take and storage half-life. The ability to improve skin graft storage techniques is most beneficial to all aspects of plastic and reconstructive surgery where skin grafting is required. Prolonged graft viability and improved graft quality are of major clinical importance.

Animals↗
PubMed1983

Inferior flap reduction mammaplasty with pedicled nipple.

A modification of the original inferior flap reduction mammaplasty is presented using a dermal pedicle based on the inferior flap to support the nipple and areola complex. The technique is extremely versatile, and the breast contour is excellent. The nipple shows excellent projection and generally improved sensation over the preoperative state.

Adolescent↗
PubMed1982

Vasospasm control by intra-arterial reserpine.

Vascular spasm may complicate both traumatic injuries and disease processes. It may be severe enough that thrombosis and vascular compromise occur, causing tissue necrosis. Transient relief may be obtained by proximal sympathetic blocks, but these are not well tolerated by the patient and require repeated injections. This study shows that a single intra-arterial injection of 1.25 mg of reserpine into the branchial artery of human volunteers with a No. 25 needle produces a prolonged sympathectomy distal to the site of injection, with cutaneous flushing, increased temperature, and increased digital pulse wave recordings. It also eliminates the vasoconstriction normally caused by a cold stimulus. Using this dose, the side effects were minimal. No complications were encountered as a result of the technique. Low-dose intra-arterial reserpine is recommended for the treatment of reversible vascular spasm.

Hand↗
PubMed1981

The pneumatic tourniquet: a biomechanical and electrophysiological study.

The pneumatic tourniquet is used routinely in extremity surgery, not only to prevent unnecessary blood loss, but also to increase the safety of the operative procedure. The mechanical part of this study shows that the system can fail in either of two major ways, each causing serious problems. The tourniquet may be inadequate if the pressure delivered to the cuff is not accurately displayed on the gauge or if the pre-set pressure is not maintained for the duration of the operative procedure. In our hospital, three of seven tourniquets (43%) in daily use showed significant errors in this regard. The electrophysiological part of this study indicates that nerve conduction does not necessarily return to preoperative levels immediately postoperatively, and that the conduction block is generally at the level of the cuff. Our observations confirm those of others and implicate both direct pressure as well as ischemia as the cause of the problem.

Arm↗
PubMed1981

The pathogenesis of pneumatic tourniquet paralysis in man.

The relative importance of ischaemic and direct mechanical injury to nerves compressed by a tourniquet, in the pathogenesis of tourniquet paralysis in man has not been established. To investigate this question, conduction in ulnar or median nerve fibres has been measured in healthy subjects both at the level of the pneumatic tourniquet and distal to the tourniquet. Measurement was prior to, for the period of tourniquet inflation, and following release of the tourniquet. The earliest conduction delays and block were observed at the level of the tourniquet, particularly across the proximal tourniquet border zone. However, a proximal to distal progression in conduction abnormalities distal to the tourniquet suggested that the earlier conduction abnormalities at the level of the tourniquet were primarily ischaemic in origin. Mechanical compression, however, probably contributed to disproportionate conduction delays and blocks across the border zones of the tourniquet.

Arm↗