Biomedical subjects
Publications and source records attributed to M J Landsman.
The diagnosis and treatment of plantar verrucae have always been a dilemma to medical practitioners. Treatment modalities and their success rates vary. This article documents the wide array of treatment options available to today's practitioner.
Although the concept of chronic neglect is used in child welfare practice, studies have not differentiated chronic cases of neglect from those of more recent onset. In this study three groups of families referred to a large metropolitan county child welfare agency for child neglect are considered: those known to the agency for three years or more (chronic group), those more recently referred and substantiated (newly neglecting group), and those in which neglect was not substantiated (unconfirmed group). Significant differences among the three study groups included family size and composition, numbers and kinds of problems, neighborhood characteristics, family relationships, parenting knowledge and expectations, and mental health. Findings demonstrate the need for changes in social policy and social services delivery systems to supplement intervention with individual families.
Physicians always are pursuing improved results. In the case of pedal verrucae, the varying treatment modalities that have evolved are the product of a search, so far less than successful, for one that is virtually 100% effective. HPV is an extremely resilient and elusive organism, possessing the capabilities of lying dormant and suddenly springing to the surface of the skin. Although no single treatment modality has been shown to be a panacea, the authors believe that, among the various treatment alternatives available, the CO2 laser offers the best surgical prospect for eliminating the verruca and minimizing the sequelae of recurrence and postoperative pain.
The use of various lasers in medicine and surgery has progressed considerably. Obviously, the sheer number of lasers being used both clinically and experimentally indicates a great potential for further advancement and refinement in technique and surgical outcomes. Although the medical field has come very far accepting and using the laser, there is still a long way to go.
We studied 36 asymptomatic children 7.7 +/- 2.5 years after a Mustard operation. Fifteen children had sinus rhythm on all electrocardiograms made during follow-up. Only 2 had normal 24-hour Holter recordings throughout follow-up, 6 had periods of supraventricular tachycardia, and 3 had periods of atrial flutter. The electrophysiological evaluation of sinus node function was normal in 5 of the 31 children who were studied. The behavior of the atrial myocardium was electrophysiologically abnormal in most of the children. Atrioventricular node function, on the contrary, was normal in nearly all of the children. Eleven children had normal hemodynamics. Four had severe or complete obstruction of the superior vena cava, 1 had a severe pulmonary venous obstruction, 3 had a severe left ventricular outflow tract obstruction, and 2 had a large left-to-right shunt. Only 3 children had normal hemodynamic and electrophysiological studies. We conclude that the absence of symptoms and a normal routine examination of children a long time after a Mustard operation does not exclude hemodynamic and electrophysiological abnormalities, which can sometimes be severe. In view of these disappointing results, we decided to replace the Mustard operation with the arterial switch operation in children with transposition of the great arteries.
This article describes a family-centered residential treatment model and presents results from a quasiexperimental study examining its effectiveness in achieving permanency outcomes for children. Greater postdischarge stability was achieved for participants in the family-centered program than in the agency's standard residential treatment service. Implications for child welfare policy and practice are highlighted.
The authors reviewed 500 distal metaphyseal osteotomy bunionectomies with smooth Kirschner (K)-wire fixation performed over a 10-year period. Postoperatively, the patients were allowed to ambulate with a forefoot compression bandage and a semirigid surgical shoe. The cases were evaluated radiographically for malunion, delayed union, nonunion, aseptic necrosis, bone callus formation, and final alignment. Soft tissue and bone infection, as well as pin irritation, were also evaluated. Computation of results demonstrated eight malunions, one delayed union, no nonunions, and two cases of aseptic necrosis. There were 52 cases (10.4%) that led to bone callus formation; 54 patients (10.8%) experienced pin irritation. A total of seven infections occurred (1.4%) that could possibly be attributed to the pin, of which four (0.8%) required incision and drainage. It was observed that certain procedures, such as the Laird osteotomy, decreased the effectiveness of the K-wire, while others, such as the Chevron osteotomy, resulted in the fewest complications. Bunionectomies performed bilaterally or with adjunct procedures, in contrast to isolated bunionectomies, were also found to decrease the effectiveness of the K-wire. Due to the minimal number of complications that were encountered and the high success rate that was attained, the authors conclude that utilization of smooth K-wire fixation for distal metaphyseal osteotomy bunionectomies remains a viable and effective treatment alternative.
Patients receiving treatment for plantar verruca by carbon dioxide laser vaporization from 1984 through 1989 were surveyed with follow-up from 3 months to 6 years. Materials and methods, operative technique, and results were reviewed. This procedure was used as both a primary treatment as well as secondary or tertiary treatments on recalcitrant verrucae. Solitary as well as multiple or mosaic lesions were evaluated. Patients were surveyed for elimination of all verrucae, partial or complete recurrence, postoperative complications, and satisfaction. The overall success rate, considering all eight treatment categories, was 75%. Ultimate success rates ranged from 93% for solitary lesions to 62% for multiple recalcitrant lesions. The authors' findings show clinical significance in the marked differentiation of success rates in accordance with the classification scheme. That is to say, initial treatment of a solitary lesion showed a higher success rate than initial treatment of multiple lesions, and initial treatment of virgin lesions showed a higher success rate than initial treatment of recalcitrant lesions. Based on the data accumulated, the authors propose that treatment of plantar verruca be initiated early, i.e., while the lesion is solitary and has been heretofore untreated. On the other hand, those lesions having a second or third treatment by carbon dioxide laser vaporization resulted in a higher ultimate success rate than those which had only one primary treatment. The general conclusion is that carbon dioxide laser management should be considered as a viable treatment alternative in relation to other, more traditional, techniques in the treatment of plantar verruca.
The authors present a case history of a patient with chronic lateral ankle pain and instability secondary to an accessory ossicle of the fibula. Conservative therapy failed to alleviate the patient's symptoms, therefore surgical management was indicated. The ossicle was excised, and a modified, double-ligament lateral ankle stabilization procedure was performed. At 12-months follow-up, the patient is symptom-free.
Despite contradictory evidence, child neglect is often believed to occur more frequently in the African American than in the Caucasian population. This article reports findings on the racial differences among 182 families referred for neglect in a large metropolitan area. Although almost all of the families were poor, African American families in the neglect sample suffered even more from economic inequality than those in the general population. Implications of the findings for social welfare policy and child welfare practice are discussed.