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Biomedical subjects

R L Ruberg

Publications and source records attributed to R L Ruberg.

At least 19 recordsLinked to original sources
PubMed2001

Lateral thoracic expansion for Jeune's syndrome: midterm results.

BACKGROUND: In 1995, we reported the use of lateral thoracic expansion in a patient with symptomatic Jeune's asphyxiating thoracic dystrophy. We have subsequently used lateral thoracic expansion 16 times on 10 patients during 7 years. This article reports our outcomes and provides surgical details. METHODS: Charts of all patients undergoing lateral thoracic expansion were reviewed. Eight of the 10 patients had symptomatic Jeune's syndrome. The other 2 had similar thoracic deformities limiting thoracic capacity. In half of the patients the procedures were performed bilaterally. RESULTS: All patients older than 1 year of age were symptomatically benefited by lateral thoracic expansion. Functional and anatomic measurements documented thoracic enlargement in several patients who had comparable preoperative and postoperative studies. However, 2 infants with significant underlying airway disease did not improve and went on to succumb to that aspect of their disease despite enlargement of the thorax. Fracture of the titanium ministruts has been a recurrent problem, and we now use larger struts. CONCLUSIONS: Lateral thoracic expansion is a safe and effective procedure in selected patients with Jeune's syndrome older than 1 year of age as judged by short-term and midterm follow-up. More experience and longer follow-up are required to discern the place of the lateral thoracic expansion in the overall management of these patients.

Adolescent↗
PubMed2000

A prosthetic breast implant infected with Mycobacterium fortuitum.

Augmentation mammaplasty is a common operation performed in the United States. Postoperative wound infections are rare, but can be devastating. Most often, bacteria from the normal skin flora cause these infections, but more atypical organisms can lead to similar situations. The authors present a case of a prosthetic breast implant infected with Mycobacterium fortuitum after augmentation mammaplasty. The patient, diagnosis, and treatment are discussed so that others may recognize and treat this entity successfully before encountering major complications. Although it is an infrequent occurrence, plastic surgeons, infectious disease specialists, and primary care doctors who may see postoperative wound infections should be aware of this potential pathogen. It is important in any postimplant infection and especially crucial in cases of unresolving or recurrent infections with unusual or even clear drainage. With proper identification through acid-fast smear and culture, multiagent therapy can be initiated early. Additional complications, including implant removal, may thus be avoided.

Adult↗
PubMed1995

Lateral thoracic expansion for Jeune's asphyxiating dystrophy: a new approach.

A new procedure is described for thoracic expansion in Jeune's asphyxiating dystrophy. The chest wall is enlarged by division of ribs and underlying tissue in a staggered fashion so that either rib or periosteum covers the lung. New bone formation has been demonstrated so that a viable enlargement has been obtained. The clinical result is excellent to date.

Asphyxia Neonatorum↗
PubMed1995

Lasting success in teenage reduction mammaplasty.

Symptomatic relief of macromastia following reduction mammaplasty in the adult female population is well documented. Teenagers undergoing breast reduction may be at risk for recurrent symptoms secondary to postoperative breast development. The psychological consequences of prominent scars, sensory loss, and inability to breastfeed may overshadow the early symptomatic relief gained from reduction mammaplasty. Eighty-six patients who had undergone bilateral reduction mammaplasty prior to 20 years of age from 1970 to 1990 were identified from hospital and office charts. Forty-eight patients (56%) were successfully contacted and completed a detailed questionnaire evaluating preoperative, postoperative, and present symptoms as well as physical and psychological consequences of their surgery. Patient age ranged from 15.0 to 19.9 years with a mean of 17.8 years. Average length of follow-up time was 5.9 years, ranging from 1.4 to 20.4 years. Sustained relief of symptoms in those patients with preoperative back pain, neck pain, shoulder strap pain, and submammary rash occurred in 76%, 78%, 89%, and 93%, respectively, despite the fact that 72% reported at least some regrowth of breast tissue. Seventy-three percent reported being happy with their current breast size, 94% would have the procedure now if they had not had the surgery as teenagers, and 94% would recommend breast reduction to a friend with macromastia. Teenage patients who undergo reduction mammaplasty do not suffer from marked return of symptoms, and long-term satisfaction remains high.

Adolescent↗
PubMed1986

Nutritional and metabolic consequences of thermal injury.

Major burns produce a variety of metabolic and nutritional consequences. The patient's metabolic rate is often doubled, and caloric demands of 3000 to 5000 calories per day are not uncommon. There are marked hormonal changes characterized by an increase in secretion of catecholamine and glucagon and a reversal of the normal insulin-to-glucagon ratio. Serum glucose increases primarily through hepatic gluconeogenesis to meet the increased demands of the burn wound and of the increased metabolic rate. Lipids may be available but they are an inefficient source of calories. Skeletal and visceral proteins are mobilized to meet the increased nutritional demands. The overall result is a severely catabolic patient in negative nitrogen balance, with decreased immunologic function and all of the wound-healing problems associated with protein and calorie malnutrition. Aggressive nutritional support (using enteral feeding whenever possible) is essential. Supplemental feedings should be started on all patients unable to reach their recommended calorie and protein requirements through regular oral diet. An increase in protein intake (calorie-to-nitrogen ratio of 100:1) may be beneficial. By establishing nutritional goals and monitoring daily weight, calorie count, protein intake, and biochemical parameters, the physician can significantly improve the chances of survival of even the most seriously injured patients.

Burns↗
PubMed1986

Nonsurgical management of burns to the lips and commissures.

Our results indicate that the nonsurgical approach in the treatment of burns of the mouth should be considered. The nonsurgical approach is less costly and less traumatic, and it yields a favorable result that is shown to be predictable.

Burns↗
PubMed1984

Role of nutrition in wound healing.

Nutritional cofactors play a major role in the wound-healing process. Deficiencies of specific nutrients, especially proteins, vitamins, and minerals, may significantly impair the healing process. The recognition of deficits and understanding of methods of repletion are a critical part of modern surgical practice.

Amino Acids↗
PubMed1984

Meshed skin grafts versus sheet skin grafts on a contaminated bed.

An experimental model was designed to test the premise that meshed skin grafts survive better than sheet grafts on contaminated wounds. In this rat model, meshing of grafts significantly improved graft take, and expansion of the mesh led to an even greater improvement. The results of this study indicate a need for further investigation of this technique in the management of contaminated wounds.

Animals↗
PubMed1984

The effect of perioperative adriamycin on skin-graft take and adherence in the rat.

This two-part study was undertaken to evaluate the effect of perioperative Adriamycin on skin-graft take and adherence in an animal model. Thirty-four male Fisher rats were divided into control and experimental groups. The controls received intravenous saline, and the experimental animals received Adriamycin 6 mg/kg (LD 10) 24 hours preoperatively. Each animal was then grafted with an autogenous split-thickness skin graft on a contiguous dermal and fascial bed. Skin-graft take was judged and measured at 7 and 14 days postoperatively. The average skin-graft take for controls was 6.1 cm2 on both the dermal and fascial beds. This was significantly better than the average skin-graft take sustained by the experimental groups of 4.3 and 3.5 cm2 on the dermal and fascial beds, respectively (p less than 0.01). Another 30 animals were divided into three control and three experimental groups. They were treated with saline and Adriamycin as before, and they underwent a similar surgical procedure. Skin-graft adherence, which was measured at 12, 24, and 48 hours postoperatively, was significantly less in the experimental groups compared with the control groups at all times measured. These data suggest that a single supratherapeutic dose of Adriamycin given preoperatively decreases skin graft take in the experimental model studied and that this decrease may be the result of a concomitant decrease in graft adherence.

Adhesiveness↗
PubMed1983

Innervated cross-leg tensor fascia lata fasciocutaneous flap for foot reconstruction.

A traumatic, extended first ray amputation in a child was treated with an innervated cross-leg tensor fascia lata fasciocutaneous flap. The flap provided thin composite tissue coverage, immobilization in a position of relative comfort, and sensory innervation to the weight-bearing surface. Consideration of this flap is recommended when dealing with large defects of the foot.

Amputation, Traumatic↗
PubMed1983

Max Thorek: a surgeon for all seasons.

Max Thorek was a leader in the field of surgery during the first half of the twentieth century. His contributions to plastic surgery included both technical advances and the recognition of the psychological import of aesthetic surgery. His technique for reduction mammaplasty (free nipple graft) is still in use today, and his principles of abdominoplasty remain applicable to modern body contour surgery.

Abdominal Muscles↗
PubMed1982

Incidence and prevention of thrombosis of the subclavian vein during total parenteral nutrition.

In this study, we were able to document by radionuclide venogram the presence of thrombosis of the subclavian vein in seven of 22 patients receiving standard total parenteral infusions. By adding 3,000 U.S.P. units of heparin to each liter of infusate, we were able to reduce the number of instances of thrombosis to two in 24 patients. Although none of the patients in the heparin therapy group experienced laboratory or clinical manifestations of anticoagulation, we suggest that further studies be done to investigate the reduced heparin concentrations to determine the lowest effective level. Based upon these observations, we currently recommend that 3,000 U.S.P. units of heparin be added to each liter of total parenteral nutrition solution infused through a subclavian venous catheter.

Female↗
PubMed1981

Clinical comparison of two 8.5% amino acid injection products.

A comparative clinical trial of Travasol 8.5% without electrolytes and FreAmine II 8.5% was performed. Thirty-six patients were admitted to the double-blind study and assigned randomly to receive either Travasol (16 patients) or FreAmine II (20 patients). All patients had abnormal renal and liver function. Nitrogen balance was compared, and metabolic complications were monitored by evaluating BUN, serum creatinine, creatinine clearance, serum CO2, SGOT, SGPT, serum LDH, and serum alkaline phosphatase. There were no significant differences found in nitrogen balance of patients receiving either Travasol or FreAmine (p greater than 0.05). The Bun for days 1--5 in the Travasol group was significantly greater (p = 0.02), but the difference (3 mg/dl) was not considered clinically significant. All other comparative measurements of renal function, liver function, and acid-base balance remained the same throughout the study period (p greater than 0.05). Based on these results, the use of either FreAmine II or Travasol can promote positive nitrogen balance in a TPN patient population with normal renal and hepatic function with no difference in metabolic complications.

Adult↗
PubMed1981

Monitoring protein requirements of the patient receiving hemodialysis and total parenteral nutrition.

A method of determining nitrogen balance in patients receiving total parenteral nutrition (TPN) and hemodialysis was evaluated. Daily nitrogen intake (NI), pre- and postdialysis weight, BUN, and creatinine values were determined. Urea-nitrogen accumulation (UNA) was calculated as the increase in total body urea-nitrogen (g) between two consecutive hemodialysis procedures. Urea-nitrogen accumulation was substituted for urine urea-nitrogen excretion in the nitrogen balance formula, and nitrogen balance was estimated as NI minus UNA. The results from eight patients were evaluated separately based on the TPN formulations administered. Group 1 received solutions containing 15 g of amino acids and 350 g of dextrose. Group 2 received solutions with 42.5 g of amino acids and 350 g of dextrose. The nitrogen intake of Group 2 (9.4 +/- 4.4 g/day, mean +/- S.D.) was greater than Group 1 (2.3 +/- 1.2 g/day), but the UNA was approximately the same for both groups (10.6 +/- 6.5 and 9.8 +/- 7.9 g/day for Groups 2 and 1, respectively). Nitrogen balance estimates for Group 2 (-0.9 +/- 8.4 g/day) were greater than for Group 1 (-7.4 +/- 7.1 g/day) with four of the seven patients in Group 2 and none of the patients in Group 1 achieving a positive nitrogen balance. The rate of rise of BUN (19 mg/dl/day) was the same for both groups. By using estimated nitrogen balance values and changes in BUN levels and BUN-to-creatinine ratios, nitrogen use by patients receiving both TPN and hemodialysis can be monitored and adequate doses of amino acids can be provided.

Acute Kidney Injury↗