Biomedical subjects
Publications and source records attributed to W A Wood.
Rectus abdominis myocutaneous flaps may be transposed through the retroperitoneum to reconstruct defects of the back and perineum. Cadaver dissections and clinical cases are presented to demonstrate the surgical technique and reconstructive possibilities of this flap.
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Biodegradative L-threonine dehydrase of Escherichia coli (radio labeled with [3H]pyridoxine) was immobilized on CNBr-activated Cl-Sepharose. The specific catalytic activity and S0.5 values of the matrix-bound dehydrase in the presence of AMP were similar to those of the soluble oligomeric enzyme in the presence of AMP (matrix-bound, associated dehydrase). When the bound dehydrase was washed with AMP-free buffer, about 50% of the bound dehydrase was removed and about 50% remained attached, as measured by radioactivity. The resulting matrix-bound, dissociated dehydrase possessed activity in the absence of AMP as is characteristic of soluble, unactivated dehydrase. The bound, dissociated dehydrase was capable of binding nearly an equal amount of soluble dehydrase in the presence of AMP; this treatment raised the specific enzyme activity of the bound dehydrase to 83% of that of the original matrix-bound, associated dehydrase. These observations correlate with the effects of AMP on the activity and quaternary structure of soluble dehydrase. When AMP was added to the matrix-bound, dissociated dehydrase, the activation observed was only a small fraction of that obtained with soluble dehydrase plus AMP. The failure of AMP to activate the major fraction of immobilized dehydrase monomer strongly suggests that dimerization is required in the activation by AMP.
It is clear from this study that the majority of foot surgical cases being done in the United States may be performed in an office-based surgical setting when individual case considerations are made on a case-by-case basis. This entire study reflects the importance of physician preference relative to selecting a surgical environment for management of disorders and surgery of the foot. In some areas, a strong consensus of opinion existed concerning one surgical location or the other, but the overwhelming majority of responses indicated a case-by-case evaluation prior to physician selection of the surgical environment. The Delphi study was well validated by the survey of Alabama podiatrists in this regard. Traditionally, within the United States, the physician has acted as an agent to the patient and as an allocator of health care resources. Perhaps current concepts regarding patient hospitalization for certain surgical procedures would change if the physician were motivated (either intellectually or financially) toward office-based surgery on a individual case basis. Perhaps, in selected elective surgical procedures, patients could be sufficiently informed so that they could voice an opinion or preference relative to selection of the surgical environment. Additional research in this area is necessary. Expanded insight into established patterns of patient hospitalization practices and general anesthesia usage on these hospitalized patients may also be in order. Realizing full well the role of independent physician judgment in these matters, it may be that selection of general anesthesia and hospitalization for some elective surgery procedures reflects the physician's training rather than his appreciation of alternate routes for rendering reasonable and responsible care.(ABSTRACT TRUNCATED AT 250 WORDS)
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In hallux varus, which may be either congenital or acquired, the great toe deviates tibialward at the metatarsophalangeal joint. Dr. Wood discusses the acquired type and its causes and treatment. A new technique involving the surgical detachment from bone of all structures located superficial to the periosteum that surrounds the distal half of the shaft of the first metatarsal has been developed. It may be used in conjunction with the available soft tissue procedures before bone surgery for correction of the deformity, and it may make bone surgery unnecessary or alter the extent and scope of any required bone surgery.
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A method of formulating total parenteral nutrient (TPN) solutions to meet specific patient requirements is discussed. A series of calculations is presented which results in a specific formula that provides the required nutrients. The input data for the calculations are the patient's 24-hour requirements for protein, calories and electrolytes. To serve as a starting guideline, baseline nutrient requirements for patients of different weights are provided. Although individualizing TPN solutions may increase the pharmacy workload, such a program can assure that patients receive optimal nutritional support.
A 13-week, advanced clinical project segment of a one-year, nonacademic pharmacy residency program in a community hospital is described. The primary responsibility of the residents is to provide clinical services, which involve close monitoring of the patient's drug therapy and understanding the patient's condition and the goals of therapy. In addition, residents are involved in teaching activities, which encompass a class on drugs for diabetic patients, a patient self-medication program for open-heart-surgery patients, a class on TPN and the emergency drug tray for a new nurse orientation program and presentations on drug topics to various nursing departments. A seminar/case study on some aspect of patient monitoring, preparation of a drug information bulletin, and a trip to either a national pharmacy meeting or well-known institutional pharmacy department round out the program. Behavioral objectives for the clinical segment of the residency are listed.
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The effect of the following variables on insulin loss from total parenteral nutrient solutions was examined: (1) time of infusion sample; (2) insulin concentration; (3) amino acid or polypeptide source; (4) electrolytes and vitamins; (5) inline filters; (6) glass and polyvinyl chloride (PVC) infusion containers; and (7) human albumin. I125-tagged insulin was added to various parenteral nutrient solutions in liter containers. These solutions were prepared and drained to simulate actual clinical use. The drained solutions were collected and measured for radioactivity, and the percent of insulin remaining in the infusion container was calculated. Basic solutions of amino acids and protein hydrolysates in dextrose with 30 units of insulin failed to deliver approximately 44 to 47% of the added insulin. Varying the concentration of insulin had a small but statistically significant effect on the degree of insulin loss. The use of inline filters and PVC bags caused an even greater loss of insulin. The addition of albumin or electrolytes and vitamins decreased the insulin loss.
Careful preoperative evaluation and precise surgical technique are important in the prevention of postoperative edema, which can alter surgical results functionally or cosmetically. If the lymphatics become occluded or injured, interstitial fluid protein concentration increases, and edema will probably result. Even mild or moderate edema may prolong healing time, and if edema persists for several weeks or months, recurrent or severe edema may result.
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