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Biomedical subjects

R Kagan

Publications and source records attributed to R Kagan.

30 records · Page 2Linked to original sources
PubMed1986

Classification and surgical correction of postburn axillary contractures.

Postburn axillary contractures should be surgically corrected as soon as the diagnosis has been established in order to avoid deeper tissue involvement. We have classified axillary contractures based upon local anatomic conditions and present procedures for correction of each type that we find most suitable. Type I contractures are characterized by a linear web at either axillary fold with minimal adjacent scarring. A double Z-plasty with Y-V advancement is the procedure of choice. Type II contractures involve either axillary fold, with adjacent skin scarring. A double incisional release on both sides of the hair-bearing area is the procedure of choice. Type III contractures are characterized by linear webs at both axillary folds without involvement of the adjacent skin. The procedure of choice in these cases is a double incisional release. Type IV axillary contractures involve the hair-bearing area and the periaxillary region. This diffuse scar contracture is best treated by a single incisional release.

Axilla↗
PubMed1984

Route of delivery for patients with immune thrombocytopenic purpura.

Over the past 15 years, we managed 19 pregnancies in 18 women afflicted with immune thrombocytopenic purpura. Our policy has been to treat the mother with corticosteroids if her platelet count was below 100 X 10(9)/L and to use cesarean section only for obstetric indications; 14 patients received corticosteroids. The perinatal outcomes were intrauterine fetal death (two), neonatal death (0), and live birth (17). The methods of delivery for the 17 live-born infants were spontaneous vaginal (seven), low forceps or midforceps (five), cesarean section (five). Although seven of the live-born infants (41%) were thrombocytopenic (less than 100 X 10(9)/L), only two received therapy, and none suffered significant hemorrhagic morbidity. Maternal treatment with corticosteroids did not affect the neonatal platelet count, nor was there a correlation between maternal and neonatal platelet counts. On the basis of our experience, we think that cesarean section is not routinely indicated as the method of delivery for parturient patients with immune thrombocytopenic purpura.

Adolescent↗
PubMedDate not supplied

Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns.

A multicenter clinical study assessed the ability of an acellular allograft dermal matrix to function as a permanent dermal transplant in full-thickness and deep partial-thickness burns. The study consisted of a pilot phase (24 patients) to identify the optimum protocol and a study phase (43 patients) to evaluate graft performance. Each patient had both a test and a mirror-image or contiguous control site. At the test site, the dermal matrix was grafted to the excised wound base and a split-thickness autograft was simultaneously applied over it. The control site was grafted with a split-thickness autograft alone. Fourteen-day take rates of the dermal matrix were statistically equivalent to the control autografts. Histology of the dermal matrix showed fibroblast infiltration, neovascularization, and neoepithelialization without evidence of rejection. Wound assessment over time showed that thin split-thickness autografts plus allograft dermal matrix were equivalent to thicker split-thickness autografts.

Adolescent↗
PubMedDate not supplied

Emergency room management of minor burn injuries: a quality management evaluation.

The vast majority of acute burns are initially seen and treated in emergency departments (EDs). Most of the individuals caring for these patients have little or no specialized training in the multidisciplinary approach to the burned patient. Burns of limited severity are treated immediately and then followed on an outpatient basis; therefore reviews of documented practices in emergency departments were not found. It was hypothesized that follow-up care may be suboptimal in this population. The medical records of 791 patients treated at three EDs in a Midwestern regional referral area from January 1991 through December 1991 were evaluated to assess the documentation of care provided. The three hospitals included a tertiary care teaching facility, a pediatric facility, and a community-based teaching hospital. Only the charts of patients treated and released from the ED were evaluated. The data demonstrate that there was suboptimal documentation of diagnosis, treatment, and follow-up care of the thermally injured patients who were initially treated in these EDs. Burn team members should develop educational and clinical relationships with EDs in the referral area to optimize both the delivery and documentation of outpatient burn care. This is especially important in today's health care environment, in which reimbursement is based on services rendered.

Adult↗
PubMedDate not supplied

Antimicrobial mixtures used to store harvested skin: antimicrobial activities tested at refrigerator (4 degrees C) temperatures.

Tissue culture media used by skin and tissue banks to store tissue were tested, with and without antimicrobial mixtures, for their ability to inhibit the growth of bacteria during incubation at refrigerator temperatures. Reductions in bacterial load were found after incubation at 4 degrees C in both the basal tissue culture media with and without the addition of antimicrobial mixtures. The presence of antimicrobials enhanced the degree and rapidity of reduction. Variations occurred among the different formulations, with or without added antimicrobials. No one formulation for either the basal tissue culture medium or antimicrobial mixture was ideal. Methods described in this study can be used to establish optimum basal medium and antimicrobial mixture formulations for general use by skin and tissue banks.

Anti-Bacterial Agents↗
PubMedDate not supplied

Lack of effect of Lactobacillus on gastrointestinal bacterial colonization in premature infants.

Studies were carried out on premature infants in the neonatal intensive care unit to determine the effect of feeding of lactobacilli on colonization of the gastrointestinal tract by antibiotic-resistant gram-negative enteric organisms. Thirty premature infants were matched by birth weight and gestational age, randomized and fed double blind either lactobacilli-containing formula or non-lactobacilli-containing formula within 72 hours of delivery. The two study groups were screened weekly by culture for stool lactobacilli, for gram-negative bacteria and for antibiotic resistance of these bacteria. Lactobacilli were cultured from the stools of 13 of 15 patients receiving lactobacilli and from 3 of 15 patients not receiving lactobacilli (P less than 0.001). Gram-negative enteric organisms were isolated during 40 of the 86 weeks (47%) of hospitalization for patients receiving lactobacilli and during 28 of 57 weeks (49%) for patients not receiving lactobacilli. There was no significant difference between the study groups in the number of resistant organisms or in the proportion of resistant organisms per gram-negative enteric isolates (4 of 40 vs. 0 of 28). These results suggest that facultative gram-negative enteric bacterial colonization, with either total or aminoglycoside-resistant strains, is not decreased by oral feedings of Lactobacillus acidophilus in premature infants.

Aminoglycosides↗
PubMedDate not supplied

Serial measurements increase the accuracy of laser Doppler assessment of burn wounds.

Traditional methods of judging burn depth by clinical evaluation of the wound based on appearance and sensation remain in wide use but are subject to individual variation by examiner. In addition to the clinical difficulties with burn wound management, observer dependency of wound assessment complicates clinical trials of burn wound therapy. A laser Doppler flowmeter with a multichannel probe was used to measure burn wound perfusion as a tool to predict wound outcome. Serial measurement with laser Doppler flowmetry had an 88% specificity and a positive predictive value of 81% for identifying nonhealing wounds. These results suggest that laser Doppler flowmetry is a potentially useful tool for burn wound assessment.

Adolescent↗