Biomedical subjects
Publications and source records attributed to W Terranova.
In certain clinical situations, coverage of scalp and forehead soft-tissue defects is best accomplished by skin graft. When bone is also exposed, however, skin graft coverage may not be possible. Flaps of periosteum can be used in these cases as bony coverage, thus providing the vascularized bed necessary for skin graft "take." Advantages and disadvantages of these periosteal flaps are discussed.
A case of an infant with median sternotomy wound infection and sternal necrosis treated by debridement and muscle flap transposition is reported. As in adults, the procedure can be done safely and successfully. Rapid healing and chest wall stability were obtained. A later cardiac procedure was performed without technical difficulties and without untoward effects on chest wall stability.
A case of attritional rupture of the flexor tendons secondary to metacarpophalangeal (MP) replacement arthroplasty for treatment of rheumatoid arthritis is reported. This complication is thought to be the result of resection of the palmar plate during the arthroplasty that was performed 5 1/4 years previously. Although not previously reported, it could be an expected late result if the palmar plate is excised during arthroplasty.
Ambulatory patients with large sacral ulcers can represent extremely challenging coverage problems. Technical options become fewer when sacral ulcers are coupled with radiation dermatitis. Latissimus dorsi free flap transfer, with direct anastomoses to sacral vessels, is described in 2 patients.
Entrapment neuropathies occur in a number of different but predictable locations in the upper extremity. These neuropathies can produce a spectrum of sensory and motor deficits in the hand and upper extremity. A careful clinical examination in conjunction with electromyography and nerve conduction velocity studies can usually delineate peripheral nerve dysfunction. Prognosis depends on the degree of nerve injury, which is related to both the cause and the duration of the entrapment.
In April 1977, fifty-nine persons became ill with type B botulism in a large, common-source outbreak. A combination of signs and symptoms that should make the clinician strongly suspect botulism was derived from the histories and ocular findings of these persons. Certain signs of third cranial nerve dysfunction reliably predicted in which patients ventilatory insufficiency would develop.
An illness characterized by high fever and pneumonia struck 2.9% of a group of the Independent Order of Odd Fellows attending a convention held in Philadelphia, in September, 1974. The convention headquarters was the hotel where the American Legion met in July, 1976. The epidemiological, clinical, and laboratory characteristics of the illness were nearly identical to those of the disease in American legionnaires in 1976. Illness was significantly associated with attendance at one convention activity held on Monday morning, Sept. 16, 1974, in the grand ballroom of the hotel. A serological survey in February and March, 1977, showed that people who had attended the convention and became ill were more likely to have raised indirect fluorescent antibody titres than persons who had attended and remained well. The illness seen in Odd Fellows members in September, 1974, was caused by the legionnaire's disease organism.
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Between March 31 and April 6, 1977, 59 individuals developed type B botulism. All ill persons had eaten at the same Mexican restaurant and all had consumed a hot sauce made with improperly home-canned jalapeno peppers, either by adding it to their food, or by eating a nacho that had had hot sauce used in its preparation. There was a highly significant association between illness and consumption of hot sauce when a comparison was made between ill persons and well controls: 4% of all restaurant patrons eating at the restaurant during the outbreak period became ill with botulism; however, approximately two-thirds of those actually exposed to the toxic hot sauce became ill. Disease severity was statistically correlated with incubation periods. No differences in disease severity were found between persons of different age groups. The full clinical spectrum (mild symptomatology with neurologic findings through life-threatening ventilatory paralysis) of type B botulism was documented.