PubMed Health⌕ Search

Biomedical subjects

S Milner

Publications and source records attributed to S Milner.

At least 19 recordsLinked to original sources
PubMed2000

The effects of hyperglycemia on skin graft survival in the burn patient.

The authors elected to determine the relative effects of hyperglycemia and/or elevated wound Gram-positive bacterial counts on success of skin graft survival in 74 burn patients. Results of serum glucose and quantitative wound biopsies on the day of admission and on postoperative day 4 were charted. Cases were separated into the following groups for analysis: normoglycemia plus normal bacterial counts, elevated bacterial counts only, hyperglycemia only, and hyperglycemia plus elevated bacterial counts. Successful graft "take" was defined as survival of 80% to 100% of the grafted area as assessed on postoperative day 4. Significant results included decreased incidence of graft take for groups with hyperglycemia only (62.5%), elevated bacterial counts only (63.3%), as well as hyperglycemia plus elevated bacterial counts (54.5%) when compared with the group with normoglycemia plus normal bacterial counts (92.8%; p = 0.020, p = 0.042, p = 0.012 respectively) for physiological parameters measured on postoperative day 4 only. Additionally, incidence of graft take was reassessed and found to be decreased significantly in groups with hyperglycemia (60.0%) vs. groups with normoglycemia (84.6%), regardless of Gram-positive bacterial counts (p = 0.034).

Burns↗
PubMed2000

The management of cubital tunnel syndrome: a meta-analysis of clinical studies.

Despite extensive clinical experience in treating cubital tunnel syndrome, optimal surgical management remains controversial. A meta-analysis of 30 studies with accurate preoperative and postoperative staging was undertaken. Patients were staged preoperatively into minimum, moderate, and severe groups on the basis of clinical presentation. Treatment modalities included nonoperative management, surgical decompression, medial epicondylectomy, anterior subcutaneous transposition, and anterior submuscular transposition. Statistical analysis using a standard SAS database with analysis of variance and chi-square tests was used to assess the efficacy of each therapeutic modality. For minimum-staged patients, all modalities produced similar degrees of satisfaction. However, total relief occurred most after medial epicondylectomy and least after anterior subcutaneous transposition. Patients treated nonoperatively had the highest rate of recurrence. For moderate-staged patients, submuscular transposition was most efficacious, whereas patients with nonoperative management fared the worst. Finally, for severe-staged patients, current therapeutic modalities were not consistently effective, with medial epicondylectomy producing the poorest operative result. This article reveals statistically significant differences in outcomes among therapeutic modalities, which may assist in treatment planning; it introduces standardized methods to aid in determining, analyzing, and communicating treatment outcomes.

Cubital Tunnel Syndrome↗
PubMed1994

Ultrasound assessment of the efficacy of wound drains.

We report the use of ultrasound in the assessment of the efficacy of wound drains in preventing wound haematoma. 171 patients with proximal femoral fractures who underwent AO dynamic hip screw or hemiarthroplasty were randomized as to whether or not they should receive wound drainage. Patients then underwent ultrasound examination on the 5th postoperative day to localize and quantify any wound haematomas. Results show that drains are effective in preventing wound collections, but only while in situ; following the removal of drains the size of resulting wound collections is the same whether the wound has been drained or not (Student's t-test; t = 0.19, NS). This study questions current theories on the mechanisms by which wound drainage is thought to influence wound healing.

Drainage↗
PubMed1993

An ethical nursing practice model.

Providing a framework within which nurses may practice is a challenge for nursing executives. The national emphasis on ethical issues and decision making provides a compelling argument for incorporating such concepts into practice models. The author discusses a nursing practice model based on five ethical principles that are applied to all aspects of nursing practice.

Beneficence↗
PubMed1991

Is patellectomy compatible with an Army career?

The aim of this study was to assess the impact of patellectomy on the service career of soldiers. Information on 184 individuals on whom patellectomy was performed between 1981 and 1986, was retrieved from computer records. The criterion for success of the operation was the recovery to a fully fit category. Fifty three patients (29%) regained full fitness. The outcome of patellectomies performed for chondromalacia patellae and osteoarthritis appears to be worse than that for patellar fractures.

Cartilage Diseases↗
PubMed1990

Surgical correction of ventricular septal defects in black and white children--an 11-year study.

The clinical and ECG features, anatomical subtypes and outcome in 309 children (169 black; 140 white; 58% female) who underwent surgical closure of ventricular septal defects (VSDs) are presented. Clinical presentation was more severe in the black children; with recurrent pulmonary infections in 65% blacks compared with 34% whites. Congestive cardiac failure was noted in 60% blacks and in 37% whites. At cardiac catheterisation a left to right shunt greater than 2.5/1 was found in 45.5% of the black and in 39.3% of the white children. Severe pulmonary hypertension (greater than 80% of systemic systolic pressure) was evenly distributed in both groups. Of the 140 white children, 74.3% underwent surgery under the age of 2 years compared with 68.6% of the 169 blacks. A perimembranous VSD was found in 65% of patients in each group. Infundibular (muscular outlet) defects were observed in 28.6% of white and 30.8% of black children. Left axis deviation (LAD) on ECG was found in 11.9% of white and 9.2% of black patients; and 93% of the total of 27 cases had a perimembranous defect. Early mortality was 3.6% in white and 7.1% among the black children. Of the 17 fatal cases in the total group, 16 had severe pulmonary hypertension. It is concluded that: (i) operative results compared favourably with those reported elsewhere; (ii) the anatomical subtypes occurred with equal frequency in both ethnic groups; and (iii) this was also the case for LAD on ECG, which was most commonly associated with a perimembranous VSD.

Child↗
PubMed1989

Aortic arch interruption in the neonate, with emphasis on early diagnosis and management.

Interruption of the aortic arch (IAA) is a rare but lethal congenital cardiovascular anomaly. Over a 3-month period we encountered 5 neonates with IAA, all of whom presented in the 1st week of life with congestive cardiac failure and diminished or absent pulses. All 5 underwent surgery, and 3 died from causes unrelated to the surgical repair. The diagnosis of this condition is difficult to make, although the absence of pulses may provide an important clinical clue (particularly if the left brachial and femoral pulses are involved). Using prostaglandins to re-establish ductal patency may be life-saving in these patients, since this restores blood flow to the lower trunk and kidneys. Administration of oral prostaglandin E2 to infants in whom this anomaly is suspected before they are referred to a tertiary care centre is therefore vital.

Aorta, Thoracic↗
PubMed1988

Liposome-bound cyclosporine: aqueous and vitreous level after subconjunctival injection.

The concentration of cyclosporine in the aqueous and vitreous humors of albino rabbits was measured, using HPLC at intervals of 24, 48, 96, and 192 hours after subconjunctival injections of 2.5 mg of free or liposome-bound cyclosporine. The aqueous concentration was reasonably high in both groups until day 4: 1050 nanograms per milliliter in the group receiving free cyclosporine, and 1438 nanograms per milliliter in the group receiving liposome-bound cyclosporine. The vitreous concentration was very low in both groups.

Animals↗
PubMed1988

Liposome-bound cyclosporine: clearance after intravitreal injection.

The concentration of cyclosporine in the vitreous after intravitreal injection of 100 micrograms of either free or liposome-bound cyclosporine was studied in albino rabbits. We found that the half-life of free cyclosporine was about 6 hours and that of liposome-bound cyclosporine was about 3 days. The finding indicates that liposome-bound cyclosporine prolongs the availability of the drug.

Animals↗
PubMed1987

Surgical correction for one pulmonary artery arising from ascending aorta--report of five cases.

Over a 10-year period we encountered 5 infants with a pulmonary artery branch arising from ascending aorta. Surgical re-implantation of this vessel was carried out at ages 2.5, 5, 8, 9, and 19.5 months. Pre-operative cardiac catheterization demonstrated severely raised pulmonary artery pressures in all, equal to systemic in 3, and suprasystemic in 2. Four patients had origin of the right pulmonary artery from ascending aorta with a left aortic arch, and the remaining patient had an anomalous left pulmonary artery associated with a right-sided aortic arch. All patients had substantial reduction in pulmonary artery pressures immediately following surgery. One patient died 18 days post-operatively from extensive lung disease. In all 4 of the survivors, post-operative cardiac catheterization (11 to 85 months after surgery) has shown a drop in pulmonary artery pressures. One patient has been left with mildly elevated systolic values but normal diastolic levels. In 2 of the children, mild stenosis has been found at the site of reimplantation of the pulmonary artery. This anomaly should always be considered as a cause in the setting of a large left to right shunt with tricuspid incompetence and severe right ventricular hypertrophy. Prompt surgical repair, after confirmation of the diagnosis, should prevent death from heart failure or the development of irreversible pulmonary vascular disease.

Aorta↗
PubMed1985

Asymmetric septal hypertrophy and hypothyroidism in children.

Any echocardiographic study of two children with hypothyroidism demonstrated the presence of asymmetric septal hypertrophy. One child died aged 11 months, and pronounced thickening of the interventricular septum was confirmed at necropsy. There was also hypertrophy of the left ventricular free wall. Histological examination showed only slight muscle fibre disarray, but there was striking vacuolation and hypertrophy of muscle fibres. In the second case, a child aged five years, the asymmetric septal hypertrophy disappeared after 18 months' treatment with L-thyroxine. Furthermore, other indices of myocardial function also returned to normal. The mechanism producing asymmetric septal hypertrophy in hypothyroidism is unknown. These are the youngest cases in which this association has been reported.

Cardiomegaly↗
PubMed1983

Patch graft aortoplasty for repair of coarctation of the aorta in infants under 1 year of age.

Patch graft angioplasty for symptomatic coarctation of the aorta was carried out in 34 infants aged from 6 days to 9,5 months (mean 49,4 days). Congestive cardiac failure was present in 32 and severe hypertension alone in 2 patients. Of the 34 children, 21 (61,8%) had significant associated cardiac lesions and 25 (73,5%) were less than 6 weeks of age. Systolic blood pressures were recorded by the Doppler technique before and after the operation. There were 6 hospital deaths (17,6%) and 3 late deaths, giving a total mortality of 26,5%. Pre-operative systolic pressure gradients between upper and lower limbs ranged from 20 to 92 mmHg (mean 54,5 mmHg). Of the 28 early survivors, 1 was lost to follow-up. Duration of follow-up ranged from 3,5 to 62 months (mean 24,5 months). Postoperative residual gradients of less than 20 mmHg were found in 19 of the 27 cases followed up (70,4%), while 8 patients had significant residual gradients (40 - 90 mmHg). Of these 8, 7 had undergone surgery when less than 6 weeks old, and 6 of them have subsequently undergone a second corrective operation. It is concluded that while patch graft angioplasty is a life-saving procedure for the correction of symptomatic coarctation of the aorta in early infancy, a significant proportion of the patients develop a recurrence of coarctation necessitating further surgery later.

Aorta↗
PubMed1982

Surgical correction of combined supravalvular and valvular aortic stenosis in homozygous familial hypercholesterolaemia.

Although premature coronary atherosclerosis is a well-recognized complication of homozygous familial hypercholesterolaemia, involvement of the aortic root and valve has not been recognized frequently during life. Two cases of supravalvular and valvular aortic stenosis due to familial hypercholesterolaemia are described. Both patients underwent successful surgical correction of these lesions. The importance of relieving left ventricular outflow tract obstruction by a technique of aortic root enhancement and oblique insertion of a prosthesis is stressed.

Aortic Valve↗
PubMed1982

Hypoplasia or absence of the depressor anguli oris muscle and congenital abnormalities, with special reference to the cardiofacial syndrome.

An asymmetrical crying facies due to hypoplasia or absence of the depressor anguli oris muscle (DAOM) was observed in 23 infants and children. The cases were divided into two groups. Group 1 consisted of 12 patients who had associated cardiac abnormalities. In group 2 were 11 patients who either had other non-cardiac abnormalities (6) or no other abnormalities (5). The associated cardiac anomalies recorded in the literature are reviewed and 2 infants in this series are reported with abnormalities not previously described. The results of chromosomal analysis have generally been found to be normal, although a patient in our series was found to have trisomy E (18). The incidence of hypoplasia of the DAOM in newborn infants in a maternity hospital hospital is assessed and was found to be lower than reported in other studies. It is concluded that a detailed and careful examination for congenital abnormalities should be carried out on every child with an asymmetrical crying facies.

Child, Preschool↗