Dealing with the ruptured silicone gel breast implant.
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Equipment Failure↗
Biomedical subjects
M G Orgel
Publications and source records attributed to M G Orgel.
A multivariate approach to the treatment of peripheral nerve transection injury: the role of electromagnetic field therapy.
A multivariate approach to the treatment of peripheral nerve transection injury has been used in a rat model. A pilot study (48 animals, 8 groups) examined variables associated with the method and timing of surgical repair, the arrest of wallerian degeneration, and the role of pulsing electromagnetic field therapy (PEMF) in functional recovery. A second phase (90 animals, 6 groups) then studied the timing and duration of pulsing electromagnetic field therapy as the only variable in larger groups of animals. The pilot study revealed that a vein-graft conduit did not improve functional recovery compared with standard epineurial repair. Additionally, delayed repair compared favorably with immediate repair. The use of chlorpromazine to inhibit the toxic effects of calcium influx appeared to enhance early functional recovery, and the combination of delayed nerve repair and pulsing electromagnetic field therapy seemed to consistently improve function. The second phase of the study has demonstrated (for the first time) statistical improvement in ambulation in animals treated with delayed surgical repair and prolonged pulsing electromagnetic field therapy. We postulate that future treatment of nerve transection injuries will involve a combined treatment regimen consisting of the immediate arrest of wallerian degeneration, delayed surgery, and pulsing electromagnetic field therapy.
Analysis of Variance↗
Full-thickness erosion of the skull secondary to tissue expansion for scalp reconstruction.
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Adult↗
Cardiovascular effects of topical 50% trichloroacetic acid and Baker's phenol solution.
Phenol and trichloracetic acid (TCA) are used for cosmetic face peeling. Deaths associated with phenol have been ascribed to the cardiotoxicity. Our purpose has been to study and compare the cardiovascular responses to these two agents in a rat model. Fifteen rats underwent abdominal epilation. Two to six days later a surface area comparable to the human face (16 cm2) was delineated on the abdomen. Baker's phenol or 50% TCA was applied to this area. Cardiac rate and rhythm and arterial pressure were monitored. Once stable, the same agent was applied to the entire abdomen for further study. TCA has been shown to be a safer agent than phenol in this rat model. Assuming that this model simulates the human response, monitoring would appear to be indicated during full-face Baker's phenol peeling.
Animals↗
Use of a tubed pectoralis major myocutaneous flap for salvage of a failed colonic bypass of the esophagus.
The use of tube PMCF as salvage for a failed colon bypass of the esophagus has not been described previously. The present report describes the technique and successful use of a tubed PMCF as a solution to the problem of a failed cervical anastomosis after colon bypass of a long distal esophageal stricture.
Colon↗
A double-split gluteus maximus muscle flap for reconstruction of the rectal sphincter.
A double-split gluteus maximus muscle flap has been described as a method for reconstructing difficult cases of rectal sphincter disruption secondary to trauma. Anatomic considerations and three case reports are documented. All three patients have derived nearly complete rectal continence after this procedure. The use of the inferior portion of only one gluteus maximus muscle preserves posterior hip stability and the proximal neurovascular supply to the portion of muscle that surrounds the anus. This procedure could potentially be used for rectal sphincter reconstruction in selected cases after ablative surgery in the anal region.
Adult↗
Xeroderma pigmentosum: oldest living survivor?
Xeroderma pigmentosum is an infrequently occurring disease characterized by premature solar skin degeneration owing to an inherent deficiency in the enzymatic process of excision repair of x-ray-induced DNA alterations. Currently, there are six known genetic forms of this disease. The presence or absence of central nervous system involvement is a manifestation of the heterogeneity of the disease. Survival beyond the third decade of life is unusual. The authors present a 46-year-old patient with proven xeroderma pigmentosum who manifests many characteristic features of this affliction and may be one of the oldest, if not the oldest, living survivor of this unusual disease.
Aging↗
Management of penile incarceration.
A case of penile incarceration is presented. Two steel bushings compromising the penile vascular supply in a young man were removed with the aid of a carbide disk dental drill. Management of this case is described, and guidelines for managing similar cases of penile incarceration are discussed.
Adult↗
Pulsing electromagnetic field therapy in nerve regeneration: an experimental study in the cat.
A multidisciplinary approach to the study of peripheral nerve regeneration in the cat has been presented. The purpose of this work has been to determine if pulsing electromagnetic field (PEMF) therapy can enhance peripheral nerve regeneration after injury. In equal groups of animals, two types of pulsing electromagnetic field treatment were compared with untreated controls. All animals underwent quantitative electrophysiologic and morphologic assessment at the area of injury. In addition, muscle fiber sizing in the periphery and retrograde labeling of anterior horn motoneurons with horseradish peroxidase were studied. Results have shown no statistical differences between the groups in electrophysiologic or morphologic parameters. However, in animals treated with a pulse-burst electromagnetic field there was a statistically significant improvement in the labeling and localization of anterior horn cells in the central nervous system. These results indicate that pulse-burst electromagnetic radiation can increase the numbers of motor neurons that reestablish appropriate connections to the periphery after nerve injury. It remains to be seen if this improved spinal cord organization can translate to improved peripheral functional return.
Animals↗
Epineurial versus perineurial repair of peripheral nerves.
A survey of clinical and experimental work concerning the efficacy of epineurial versus perineurial suture techniques for the treatment of peripheral nerve disruption has been presented. It seems that little differences result from the utilization of either of these methods. Therefore, suture of the outer epineurium is the technique of choice for most acute nerve lacerations, since it is easier, faster, and requires less manipulation of the delicate internal neural structure. Clinical indications for outer epineurial or inner epineurial (group funicular) repair have also been discussed. The reasons why these techniques lead to similar results remain unclear. However, it would seem to be impossible to align individual axons if their vast numbers and the dynamic disruptive phenomena that occur after nerve transection are taken into account. It is now recognized that peripheral nerve regeneration studies must address events occurring at the level of the injury and additionally in the periphery and the cell body itself. The answer to the clinical problem of nerve transection will lie in our ability to manipulate axonal regeneration from the central nervous system to correct peripheral end organs. This question will not be solved by the position in which suture material is placed.
Animals↗
Pressure sores.
Pressure, hygiene, spasticity and chronic infection are the important local factors in pressure ulceration. Hypoproteinemia, nutritional deficiency and anemia are the systemic factors. Careful attention to local wound care and dietary supplements is required. Muscle and myocutaneous flaps may provide better coverage than the traditional random pattern flaps. Flaps with sensibility have theoretic advantages but need further investigation.
Bacterial Infections↗
Experimental studies with clinical application to peripheral nerve injury: a review of the past decade.
A great deal of information concerning nerve regeneration after injury and repair has been developed during the past decade. Technologic advances concerned with the mechanics of repair have probably reached their nadir and other means of promoting more efficient central to peripheral connections will need to be sought. Studies which relate central nervous system regenerative events to those occurring in the periphery should provide additional needed information. At this time research workers must concentrate on control of scar formation at the suture line and the correct orientation of regenerating axons toward their peripheral connections. These goals will most likely be achieved by biochemical manipulations at the cellular level.
Animals↗
A comparison of light and scanning electron microscopy in nerve regeneration studies.
An assessment of qualitative axonal regrowth after injury using standard light microscopy compared to scanning electron microscopy has been presented. The superior resolution of the scanning electron microscope demonstrates a view of axonal surface anatomy not previously available. Once certain technical problems have been resolved, these methods should become routine in nerve regeneration research.
Animals↗
Self-inflicted gunshot wounds to the face: a review of 18 cases.
A 9-year experience at the University of New Mexico affiliated hospitals involving 18 patients with self-inflicted gunshot wounds to the face is reviewed. Almost all were young males, averaging 27.9 years of age. Fourteen patients were Native American, six from the same pueblo. Four shootings were 'accidental' and the rest suicidal. Sixteen patients were intoxicated at the time of injury. Interpersonal conflict with an important female and acculturation difficulties were thought to play major roles. Rifles were most commonly used, and injuries tended to be severe. High muzzle velocity (greater than or equal to 2,000 ft/sec), high muzzle energy (greater than or equal to 2,000 ft-lbs) weapons tended to be the most injurious, and low muzzle energy (less than or equal to 1,000 ft-lbs) guns were related to a lesser extent of injury regardless of muzzle velocity. Patient compliance during reconstruction has been excellent, and functional return to society with gainful employment and a stable marriage has been the rule. Subsequent suicide attempts have been uncommon.
Adolescent↗
Upper extremity replantation.
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Adolescent↗
Electrical burns of the mouth in children; a method for assessing results.
A retrospective study has been reported of a 15-year experience with electrical burns of the mouth in children. Addtionally, a method has been described by which the surgical results to date can be measured. It seems that the means of initial treatment (excision vs. conservative) does not influence the final results, but rather the extent of injury is probably the crucial factor. Because of a high incidence of significant bleeding from the labial artery, and the concept of early wound excision to diminish late scaring, we continus to favor initial delayed primary excision.
Burns, Electric↗