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Biomedical subjects

T J Dubrow

Publications and source records attributed to T J Dubrow.

At least 19 recordsLinked to original sources
PubMed1994

Latex allergy: an intraoperative hazard.

First described in 1979, immediate hypersensitivity to latex has been occurring with increasing frequency. Though it has not been reported in the plastic surgery literature, hypersensitivity to rubber can present in the operating room with symptoms that range from mild urticaria to frank anaphylactic shock. Frequent contact with latex products appears to predispose certain groups to hypersensitivity. Diagnostic testing is not yet standardized and, when latex allergy is suspected, referral to an allergist is appropriate. Hypersensitive patients may be operated on safely with premedication and avoidance of latex products.

Adult↗
PubMed1993

A new nerve pedicle for finger sensibility: the dorsal digital sensory nerve.

Restoration of sensibility to the traumatized finger can be a difficult problem. Two patients with insensibility to the volar distal finger after trauma underwent delayed digital nerve repair. In the first patient, the dorsal branch of the radial proper digital nerve was approximated to the distal stump as a pedicle to span a 12-mm gap resulting from neuroma excision. The second patient had a 14-mm defect after scar-tissue excision 8 months following primary neurorrhaphy after trauma. Reconstruction was performed by approximating the dorsal branch of the radial proper digital nerve to the distal stump. Both patients had fingertip sensibility restored 1 year postoperatively, as documented by two-point discrimination. Anatomic dissections of 12 fresh cadaver fingers revealed a consistent pattern. Of the 24 proper digital nerves dissected, 23 had a distal dorsal sensory branch arising at the midportion of the proximal phalanx. The dorsal branch-vascularized pedicle of the proper digital nerve has not been described previously as a method for restoring finger sensibility in cases not amenable to primary neurorrhaphy. We believe this technique should be added to the repertoire of the practicing hand surgeon.

Adult↗
PubMed1993

Management of large scalp defects with local pedicle flaps.

Recent reports have emphasized free-flap reconstruction for large defects of the scalp and calvarium following resection of tumors, infection, or trauma. In most cases, however, a carefully planned local transposition or rotation flap may be equally effective, and the technical difficulties and donor-site problems associated with microsurgical tissue transfer are then avoided. We present 10 patients whose full-thickness scalp defects covered an average area of 241 cm2, or 27 percent, of the skull surface. Although this series included defects as large as 450 cm2, or 50 percent, of the skull surface area, each was easily managed with a local pedicle flap transfer. Four patients were reconstructed with parietal scalp transfer, four with an occipital scalp flap, and two with temporal scalp transfer. The technique and results are discussed.

Adolescent↗
PubMed1992

Guidelines for surgical residents' working hours. Intent vs reality.

To comply with voluntary California medical school guidelines, our general surgery residency program reduced in-house call to 1 in 4 nights, and scheduled a 72-hour work-week. We assessed the effectiveness of these changes by prospectively surveying the actual working hours of surgical house staff through completion of a daily schedule for 1 month. Actual in-hospital hours averaged 98 per week, significantly exceeding the scheduled hours, and were greater for interns (100 hours) and junior residents (97 hours) than for chief residents (95 hours). Twenty hours (22%) of nonconference waking hours were spent on so-called scut work. Significant reduction of intern work hours could be accomplished by expansion of ancillary care, allowing more time for direct patient care. The effect on senior house staff hours would be less dramatic but might be sufficient to bring hours into compliance with proposed limits.

General Surgery↗
PubMed1992

The effect of fibrin glue on intraperitoneal contamination in rats treated with systemic antibiotics.

Intraperitoneal fibrin sealant lowers septic mortality in a rat model of peritoneal contamination (2 x 10(6) organism inoculum) at the cost of increased late intraabdominal abscesses. This study utilized parenteral antimicrobials to determine if the protective effect of intraperitoneal fibrin could be achieved without increasing the late abscess formation rate. One hundred and fifty-five rats were divided into four groups. Gelatin capsules containing various dilutions of feces (10(10) CFU/ml) and barium sulfate were placed into the abdomen in all groups. Group I controls had no antibiotics or fibrin. In group II, the capsule was surrounded by a solution of cryoprecipitate, thrombin, and calcium (fibrin "glue"). Groups III (no fibrin, antibiotics) and IV (fibrin, antibiotics) received a broad-spectrum cephalosporin intramuscularly postoperatively and then daily. Surviving rats were sacrificed on the tenth postoperative day. At a moderate volume of fecal inoculum (0.3 ml), fibrin reduced mortality from 100% in the control group to 0% in treated animals (P less than 0.001) that did not receive antibiotics. Abscesses formed in 10% of the surviving fibrin-treated rats which were implanted with 0.1 ml of inoculum. In the 0.2 and 0.3 ml inoculum groups substantially more abscesses occurred (75 and 70%, respectively). The protective effect of fibrin was not manifested in the antibiotic-treated rats since no deaths occurred in either group. At higher and lower inoculum doses, no significant differences between fibrin and control groups were observed in mortality or abscess formation, whether or not antibiotics were given.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1990

Upper eyelid ptosis correction by a revised tarsal resection technique.

Many techniques have been developed for the correction of eyelid ptosis. A new tarsal plate resection technique is described for use in cases of minimal ptosis with fair to good levator function. The procedure involves a horizontal lenticular excision of the tarsal plate, placed so that equal amounts of tarsus remain above and below the excision. The height of the excision is equal to the amount of ptosis correction desired, as determined in the preoperative examination. This precision in surgical correction is the chief advantage of the procedure. The technique also spares Müller's muscle, thus retaining the lid-elevating action of that muscle. Good results have been achieved in 6 patients, some showing excellent results after nine years.

Adolescent↗
PubMed1990

Malignant hyperthermia in the otolaryngologic patient: prospective anesthetic and surgical management of eight children.

Malignant hyperthermia (MH) is a rare genetic myopathy whose hallmark is rise in body temperature. This hypermetabolic state is triggered by inhalational anesthetics and/or depolarizing muscle relaxants such as succinylcholine. Even the use of dantrolene may not be protective against the hypermetabolic crisis. Eight patients at risk for MH undergoing tonsillectomy, adenoidectomy, and/or myringotomy with ventilation tube insertion were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants without dantrolene and without complication. Cardiac monitoring and rectal temperatures were followed. In order to provide additional evidence, all eight patients had vastus lateralis muscle biopsies with subsequent caffeine-halothane contracture studies performed. The contracture study showed positive results in seven of eight patients studied, indicating MH-susceptible muscle. No anesthetic or operative complications were encountered. This study demonstrates that patients at risk of developing MH crisis can have otolaryngologic procedures performed relatively safely while undergoing appropriately selected anesthesia.

Adenoidectomy↗
PubMed1990

Exposed endoprosthesis. Management protocol using muscle and myocutaneous flap coverage.

A tenet in the orthopedic community is that dehiscent wounds overlying exposed prostheses should be treated by implant removal and delayed reconstruction. A management protocol using thorough debridement and irrigation and muscle flap coverage was accomplished in four patients with exposed endoprostheses after total arthroplasty or limb salvage surgery. Predisposing factors for late wound dehiscence in the four oncology patients were preoperative radiation and chemotherapy as well as multiple subsequent reoperations. In this study, all four prostheses and extremities were retained without the need for prosthetic removal or exchange. No infections developed. Late aseptic wound dehiscence with exposed conventional or tumor endoprosthesis need not be managed with prosthetic removal, arthrodesis, or amputation. This one-stage procedure avoided infection, allowed early mobilization, shortened hospitalization and, most important, avoided amputations.

Adult↗
PubMed1990

"Sensible" flap coverage of pressure sores in patients with meningomyelocele.

Restoration of sensibility in the paraplegic patient is the optimal therapy for the management and prevention of debilitating pressure sores. In patients with an absence of sensibility below the L3 spinal level, a locally transposed arterialized neuromyocutaneous gracilis flap may be uniquely utilized for ischial restoration of sensibility. Two patients with meningomyelocele-induced ischial pressure sores underwent local innervated neuromyocutaneous gracilis flap transposition to insensate areas from below the anatomic level of recipient insensibility. A 10-year follow-up revealed maintenance of sensibility in the flap and spread of sensibility to adjacent insensate areas with no evidence of pressure sore recurrence. Cadaver dissection and clinical Xylocaine injection demonstrated that the cutaneous sensory innervation to this flap is by means of a consistent sensory branch from the deep neurovascular pedicle, which coincides with the L1-L3 dermatome.

Adolescent↗
PubMed1989

Total gastrectomy in the treatment of advanced gastric cancer.

To assess the role of total gastrectomy in the treatment of advanced gastric cancer, we reviewed the records of 27 patients who underwent the procedure from 1979 to 1988. Operative mortality was 4 percent (1 of 27), and postoperative morbidity occurred in 48 percent of the patients. Twenty-five of 26 patients were tolerating solid food at the time of discharge; 21 were able to maintain oral alimentation until just prior to their death. Median survival following the operation was 15 months (range: 2 to 110 months), with a 62 percent absolute 1-year survival rate and a 38 percent 2-year survival rate. On the basis of these results, we conclude that in patients with advanced gastric carcinoma, total gastrectomy with Roux-Y esophagojejunostomy can be performed with an acceptable morbidity and mortality, provides significant palliation by restoring the patient's ability to eat, and should be performed when technically feasible, even in the presence of gross residual disease.

Adult↗
PubMed1989

Detection of multiple cardiac papillary fibroelastomas using transesophageal echocardiography.

Papillary fibroelastomas are rare, benign cardiac tumors that may be associated with embolization, angina, and sudden death. We report a case of multiple papillary fibroelastomas diagnosed during life by transesophageal echocardiography. Surgical resection during mitral valve replacement for rheumatic mitral stenosis prevented the development of any of the life-threatening complications sometimes associated with this tumor.

Echocardiography↗
PubMed1989

Malignant hyperthermia: experience in the prospective management of eight children.

Malignant hyperthermia (MH) is a seemingly rare genetic myopathy. Hypermetabolic crisis accompanied by a rise in body temperature to as high as 44 degrees C, is its hallmark. Malignant hyperthermia is usually triggered by potent inhalation anesthetics and/or depolarizing muscle relaxants. Because of the extraordinary incidence of death in patients who are at risk, pediatric surgeons may be reluctant to operate on these patients. Eight such patients were referred to the Pediatric Surgery Service and the UCLA Malignant Hyperthermia Center following pediatric surgical procedures aborted for first episodes of malignant hyperthermia (five) or for a strong family history of malignant hyperthermia (three). They were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants. The patients were not treated prophylactically with dantrolene. Cardiac monitoring, end-tidal PCO2, and rectal temperatures were monitored. After completion of their pediatric surgical procedures, all eight patients had a vastus lateralis muscle biopsy performed and subsequent caffeine/halothane contracture studies completed. The contracture study result was positive in all patients studied. No anesthetic or surgical complications were encountered. This study shows that patients at risk for developing MH crisis can have pediatric surgical procedures performed safely with appropriately selected general anesthesia.

Adolescent↗
PubMed1989

Acne of the heel: acne vulgaris complicating a free vascularized latissimus dorsi musculocutaneous flap.

An interesting case of acne vulgaris complicating a free vascularized latissimus dorsi musculocutaneous flap used for heel reconstruction is presented. The development of acne in a free musculocutaneous island transfer has not been described before, and we speculate as to its cause. We conclude that quiescent donor site acne scarring may be a contraindication to the use of free skin flap transfer for soft tissue reconstruction.

Acne Vulgaris↗
PubMed1989

Muscle-flap coverage of exposed endoprostheses.

A well-entrenched tenet in the orthopedic community is that dehiscent wounds overlying exposed endoprostheses should be treated by implant removal and delayed reconstruction. A new management protocol utilizing thorough soft-tissue debridement and myocutaneous or muscle-flap coverage was evaluated in four patients at the UCLA Medical Center who presented with exposed endoprostheses. These prostheses were placed for total-joint replacement or limb salvage surgery. All four prostheses and extremities were salvaged without the need for endoprosthesis removal or exchange, and no infections developed. The results suggest that late aseptic wound dehiscence with an exposed endoprosthesis need not be managed with prosthetic removal, arthrodesis, or amputation. This one-stage procedure avoided infection, allowed early mobilization, and shortened hospitalization.

Adult↗
PubMed1989

Myocardial contusion in the stable patient: what level of care is appropriate?

To evaluate the significance of myocardial contusion, we evaluated 243 stable patients hospitalized for blunt chest trauma between 1982 and 1986. The groups were identified according to results of radionuclide angiography, mean injury severity score (ISS), and outcome. Group I (n = 71; mean ISS = 12.7) patients were those without myocardial contusion by radionuclide angiography. Two patients with cardiac complications were in this group. The patients with myocardial contusion were divided into two groups. Group II (n = 69; ISS = 19.5) patients had myocardial contusion as an isolated injury, and group III (n = 103; ISS = 30.9) patients had myocardial contusion and injury to at least one other organ system. Three patients from group II had cardiac complications. Eleven patients from group III had cardiac complications. There were no significant differences between the cardiac complication rate in the three groups, and each complication was present when the patient arrived in the emergency department. The predicted mortality rate based on ISS was 10% to 20% for patients with myocardial contusion, whereas the observed mortality rate for the groups (II and III) overall was 0.58%. We conclude that in the stable trauma patient myocardial contusion (1) does not by itself increase the risk of complication, (2) does not necessitate intensive care unit monitoring, (3) should be devalued when computing ISS scores, (4) may account for lengthy and often unnecessary hospitalization, and (5) in patients at risk for complications may be identified by ECG abnormalities on arrival to the emergency department.

Adolescent↗
PubMed1988

Detailing the human tail.

There have been 23 true vestigial tails reported in the literature since 1884. A new case is described, and its magnetic resonance imaging and pathological features are presented. A review of the literature and analysis of the pathological characteristics reveal that the vestigial human tail may be associated with other abnormalities. Vestigial tails contain adipose and connective tissue, blood vessels, and nerves and are covered by skin. Bone, cartilage, notochord, and spinal cord elements are lacking. Tails are easily removed surgically without residual effects. Since 29% (7 of 24) of the reported tails have been associated with other malformations, careful clinical evaluation of these patients is recommended.

Animals↗
PubMed1988

Neurosurgery in the malignant hyperthermia-susceptible patient.

Malignant hyperthermia is a seemingly rare genetic myopathy. Hypermetabolic crisis accompanied by a rise in body temperature to as high as 44 degrees C is its hallmark. Malignant hyperthermia is usually triggered by potent inhaled anesthetics or depolarizing muscle relaxants. Because of the extraordinary risk of death in patients who are susceptible, neurosurgeons may be reluctant to operate on these patients. Three such patients were referred to the Neurosurgery Service and the UCLA Malignant Hyperthermia Center after neurosurgical procedures aborted for first episodes of malignant hyperthermia. They were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers, and nondepolarizing muscle relaxants. The patients were not treated prophylactically with dantrolene. Cardiac monitoring, end-tidal pCO2, and rectal temperatures were followed. After completion of the neurosurgical procedures, all three patients had a vastus lateralis muscle biopsy and subsequent caffeine/halothane contracture studies. The contracture study was positive in all patients. No anesthetic or surgical complication was encountered. This study demonstrates that neurosurgical procedures can be performed safely in patients at risk of developing malignant hyperthermia while they undergo appropriately selected general anesthesia.

Adult↗