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T Raff

Publications and source records attributed to T Raff.

25 records · Page 2Linked to original sources
PubMed1996

Hematogenous osteomyelitis of the hand skeleton in adults after dental maxillary infections.

Hematogenous ostemyelitis is infrequently seen in adults and primary involvement of the hand skeleton is extremely rare. Little has been reported about the foci of hematogenously spread infections. Two cases of hematogenous osteomyelitis of the hand originating from dental maxillary infections were reported. The first patient suffered an acute hematogenous osteomyelitis of the wrist join, spreading from dental granulomas and massive periodontitis. Despite early radical debridement, attempts to salvage the wrist joint and the extensor tendons failed, so that a wrist fusion had to be performed. The functional outcome was poor. The second patient demonstrated a chronic hematogenous osteomyelitis of the fourth and fifth metacarpals originating from chronic maxillary sinusitis. Radical debridement and use of "spare parts" of the fifth metacarpal prevented an amputation of the fourth ray. The functional outcome was excellent. These cases emphasize the importance of including an examination of the dental maxillary area when searching for a primary focus of hematogenous osteomyelitis.

Adult↗
PubMed1996

Factors influencing the early prediction of outcome from burns.

OBJECTIVE: 1. To reexamine the predictive value of the variables usually used in admission scores in burned patients (age, total body surface area burned (TBSAB), full thickness burn (FTB), inhalation injury (IHT) and sex). 2. To evaluate whether risk factors (alcohol abuse (AA), nicotine abuse (NA)) or preexisting diseases influence outcome significantly. DESIGN: Retrospective study of prospectively collected data. PATIENTS: 498 burned patients admitted to the burn ICU within a 5 years period. The mean TBSAB was 29% and the mean age 38 years. 42% of the patients suffered burns greater than 30% and the incidence of IHT amounted to 43%. METHODS: Univariate analyses were used to determine the independent relation of the variables to mortality. The relative weight of the variables was estimated using the step-wise logistic regression model. An additional analysis of subgroups was performed using classification and regression trees (CART). RESULTS: The univariate analyses identified the following variables to have significant influence on mortality: age, TBSAB, FTB, IHT, sex, AA, NA, the combination of AA and NA, preexisting neurological diseases and cardiovascular diseases. The step-wise logistic regression analysis identified age and TBSAB to have the most important influence on the outcome. Of minor weight was IHT followed by FTB and sex. The weight of IHT was found to be 1.7 fold higher than the impact of FTB and sex. A significant influence of IHT was found in all patients, but especially in patients with a medium risk of death (20%-45%) regarding age and TBSAB. In this group AA and NA additionally caused a significant impact on mortality. In patients with a higher or lower probability of survival AA and NA did not influence the outcome. The CART analysis identified TBSAB to be the most discriminative variable followed by age. In the group up to 20% TBSAB age was the only additionally significant variable regarding the outcome. In the group with a TBSAB between 20% and 60% age, sex and AA became important variables. In patients up to 72 years with a medium risk of mortality (20%-70%) IHT, AA, combined AA and NA, sex, preexisting neurological diseases and cardiovascular diseases significantly influenced outcome. In older patients IHT was the only additional variable of importance. CONCLUSIONS: The study demonstrates that besides the "classical" variables of bum scores as age, TBSAB and IHT other variables such as sex, AA, NA and preexisting diseases have significant influence on the outcome. These variables especially gain important predictive value in patients with a medium risk of mortality.

Adult↗
PubMed1996

Experience with the modified Meek technique.

In 1958 Meek described the so called Meek-Wall dermatome to cut postage stamp skin grafts. This method was eclipsed by the introduction of mesh skin grafts. In 1993 Kreis and colleagues reintroduced a modified Meek technique using a dermatome running on compressed air. This technique has been used in our burn unit since August 1994. The aim of this paper is to compare the modified Meek technique with the mesh graft technique. Within a period of 20 months 41 patients were grafted using the modified Meek technique. The mean TBSAB was 54.4% with 50.0% full thickness burns. All patients were excised early. The expansion ratio was 1:4 and 1:6. In 20 patients the Meek technique was used exclusively for grafting of the trunk and the extremities with the exception of face, neck and hands. In 3 patients with a mean TBSAB of 68.3% a combination of postage stamp autologous skin grafts and cultured epithelial autografts (CEA) was applied. Compared with the mesh graft technique the Meek technique showed the following advantages: 1. The Meek method provides the true expansion ratio. 2. Small graft remnants can be utilized. 3. Grafting of full thickness burns up to 70 to 75% TBSAB becomes possible with one harvest of the donor sites. 4. The reliability of graft take is equal or better. 5. Epithelialization is achieved within 3 to 4 weeks depending on the expansion ratio. 6. The combination of widely expanded postage stamp split thickness grafts and CEA provides an excellent take rate and durable wound closure within a short time and avoids the problems associated with the engraftment of CEA on fascia. The method is simple but more demanding than the mesh technique. Compared with the mesh graft technique the preparation of Meek grafts is more time consuming and requires more staff than the Mesh technique. The cost of materials is higher. In our experience complete coverage of the Meek grafts with an overlay of meshed allografts after removal of the gauze as recommended by Kreis is not necessary using the 1:4 expansion ratio. Greater expansion ratios necessitate an overlay with meshed allografts. Regarding the scar formation no significant differences were observed compared with the mesh graft technique. In conclusion the modified Meek technique is reliable and simple to perform. This technique provides a sufficient expansion ratio enabling to graft patients with burns up to 75% TBSA with only one harvest of donor sides and without the necessity of CEA. In our opinion the Meek technique is reliable and simple to perform. This technique provides a sufficient expansion ratio enabling to graft patients with burns up to 75% TBSA with only one harvest of donor sides and without the necessity of CEA. In our opinion the Meek technique is advantageous in patients with burns greater than 45% TBSAB. In smaller burns mesh grafts should be used because of lower material cost and staff requirements. Especially in extensively burned patients the Meek technique may be cost effective avoiding the need of CEA.

Adolescent↗
PubMed1995

[Primary pulmonary B-cell lymphoma of the MALT type].

The malignant B-cell lymphoma of the MALT-type shows significant differences from nodal lymphomas with respect to its biological, molecular genetic, and clinical properties. According to the proposal from the International Lymphoma Study Group for a Revised European-American Classification of Lymphoid Neoplasms, MALT-B-cell lymphomas have been defined as an extranodal subgroup of marginal zone B-cell lymphomas and may have lower and higher grade types. We have applied this classification to 24 cases of primary B-cell lymphomas of the lung. These tumors showed histopathologic features of low (n = 20) and/or high grade neoplasms (n = 4) recapitulating the structure of the acquired bronchus-associated lymphoid tissue (BALT). According to our experience, the diagnosis of BALT-type B-cell lymphoma, is both practically feasible and reproducible not only for surgical material but even for biopsy specimens.

Adult↗
PubMed1995

Two new applications for the first dorsal metacarpal artery pedicle in the treatment of severe hand injuries.

Two new indications for the use of the first dorsal metacarpal artery (1st DMA) in reconstruction following severe hand injury are reported. In the first case, a primary pollicization of the index finger was based solely on the dorsal arterial network. The second case involves a microvascular arterial revascularisation of a 1st dorsal metacarpal artery island flap. Neither procedure has previously been described.

Arteries↗
PubMed1995

[Homograft transplantation in severely burned patients. Principles, indications and possibilities].

Homologous skin transplantation has recently gained increased importance in treatment concepts of severely burned patients. It is used as optimal biologic dressing and serves as dermal matrix in autologous-homologous intermingled transplantations or in cultured epithelial cells (keratinocytes). The present clinical indications for homologous skin and the theoretical basics are demonstrated.

Burns↗