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At least 1,027 records · Page 57Linked to original sources
PubMed1983

The transverse abdominal island flap: part I. Indications, contraindications, results, and complications.

The transverse abdominal island flap is not just another myocutaneous flap. Although it derives its blood supply from myocutaneous perforators, the portion of the skin and fat that overlies muscle comprises only about 20% of its surface. The surface area of the flap by far exceeds the surface area of the entire muscle that carries it. Its hemodynamics are more complicated than usual and consist of delicate communications between the superior and inferior deep epigastric systems and the deep and superficial epigastric systems across the midline. Its use in breast reconstruction has been as exciting as it is complex. We describe our experience with 60 consecutive patients and 65 transverse abdominal island flaps.

Abdominal Muscles↗
PubMed2001

Nipple piercing may be contraindicated in male patients with chest implants.

The authors present a man who underwent chest augmentation and nipple piercing. The patient developed chronic nipple infection, which led to unnecessary invasive diagnostic procedures, serious implant infection, and eventually urgent explantation. This unfavorable scenario illustrates the distinct features of the procedure in men, which includes close proximity of the nipple to the implant and reduced awareness by health care providers. Based on this case the authors recommend avoiding nipple piercing in men with chest implants.

Cosmetic Techniques↗
PubMedDate not supplied

Heterotopic ossification: are range of motion exercises contraindicated?

The incidence, time of onset, and role of exercise in the progression of heterotopic ossification were documented retrospectively in burn patients. In 12 of 1,066 patients (1.2%) consecutively admitted to a burn center, the abnormal bone formed posteriorly around the elbow joint. The initial signs were localized joint pain and rapid decrease in range of motion, and the average time of onset was 12 weeks after thermal injury. Prior to the diagnosis of heterotopic ossification, all patients were managed with an exercise program of active and active-assisted movements. In patients who persisted with passive and active-assisted range of motion, especially beyond the range of pain-free movements, the ossification progressed to complete ankylosis and required surgical intervention to remove the heterotopic bone. On the other hand, postoperative patients and patients who followed a program of active exercise within the pain-free range gained excellent range of motion. It was concluded that passive stretching of the periarticular structures during the acute phase of heterotopic bone formation is detrimental to the final outcome.

Adult↗
PubMed1999

Acoustic neuroma surgery: absent auditory brainstem response does not contraindicate attempted hearing preservation.

OBJECTIVE: Absence of auditory brainstem response (ABR) waveforms has been associated with a poor likelihood of hearing preservation following resection of acoustic neuromas. Our experience is reviewed for patients with absent preoperative ABR regarding hearing preservation, hearing improvement, and return of ABR. STUDY DESIGN: Retrospective review of 22 cases of acoustic neuroma resection. Nine patients with absent preoperative ABR were identified. All underwent tumor resection utilizing intraoperative cochlear nerve action potential (CNAP) monitoring. Postoperative hearing results and ABR waveforms were examined. METHODS: Charts were reviewed and tabulated for age, sex, tumor side, tumor size, preoperative and postoperative audiometric and ABR results, intraoperative monitoring results by ABR and CNAP, and surgical complications. RESULTS: Hearing preservation was achieved in seven of nine patients (78%) with absent preoperative ABR, as well as six of seven patients (86%) with tumors less than or equal to 20 mm in greatest dimension. Although intraoperative ABR monitoring was not possible in any of these patients, CNAP monitoring was successful in all. Return of ABR waveforms was observed in four of the six patients (67%) tested from 3 to 22 months postoperatively. Four of the seven patients (57%) enjoyed improvement in hearing class as defined by the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery. CONCLUSIONS: Absent ABR waveforms have not been a negative prognostic sign regarding hearing preservation. CNAP monitoring is possible in these patients and likely helps to minimize iatrogenic cochlear nerve trauma. Patients with no ABR waveforms have hope of hearing preservation and even improvement following acoustic neuroma resection performed utilizing CNAP monitoring and hearing preservation surgical techniques.

Aged↗
PubMed2001

Impact of exercise on bone health and contraindication of oral contraceptive use in young women.

PURPOSE: The effect of quantified resistance and high impact exercise training on bone mass as modified by age and oral contraceptive (OCont) use in young women was studied. METHODS: Women were categorized by age (18-23 vs 24-31 yr) and OCont use, and were then randomized into either three sessions of resistance exercise plus 60 min.wk-1 of jumping rope or a control group for 24 months. Total body, spine, femoral neck, greater trochanter, Ward's area, and radial bone mineral density (BMD) and/or content (BMC), biochemical markers of bone turnover, dietary intake of calcium, lean body mass, maximal oxygen uptake, and strength were determined at baseline and every 6 months. RESULTS: Total body (TB) BMC percent change from baseline was higher in exercisers compared with nonexercisers at 6 and 24 months. OCont users had lower bone turnover at baseline and a decrease in TBBMC from baseline compared with non-OCont users at 24 months. Spine BMC and BMD decreased in the exercise and OCont group at 6 months and remained significantly below nonexercisers who used oral contraceptives at 2 yr. Femoral neck BMD also decreased in the exercise and oral contraceptive group at 6 months. CONCLUSIONS: Exercise prevented a decline in TBBMC seen in the nonexercisers. On the other hand, exercise in oral contraceptive users prevented the increase observed in the spine of the nonexercise plus OCont group.

Adolescent↗
PubMed1988

Adenotonsillectomy in children: indications and contraindications.

Adenoidectomy and tonsillectomy are the most common major operations done on children. The indications for tonsillectomy in certain clinical situations are constantly being debated in the literature and among professionals. We studied the efficacy (or lack of it) of adenotonsillectomy for chronic tonsillitis (recurrent throat infections), oral nasal obstruction, peritonsillar abscess, elimination of a bacterial carrier state, biopsy, and prevention of tongue thrusting with resultant anterior open bite. Adenoidectomy has been advocated in the literature for the treatment of nasal obstruction, sinusitis, and chronic serous otitis media. Complications of tonsillectomy and adenoidectomy include hemorrhage, anesthetic death, infection, nasopharyngeal stenosis, patulous eustachian tube, and hypernasality. Children at risk for hypernasality are those with mental retardation, cerebral palsy, neuromuscular disorders, and submucous cleft of the soft palate. Because of the severity of the complications that can be encountered in any child, medical and conservative therapy should be attempted before operation is done. Proper antibiotic therapy will often control chronic serous otitis, sinusitis, and chronic, recurrent tonsillitis. Bacterial synergy is important to consider when selecting antibiotic therapy, since beta-lactamase production may protect pathogens commonly considered susceptible to standard antibiotic therapy.

Adenoidectomy↗
PubMed2005

Relative prevalence of comorbidities and treatment contraindications in HIV-mono-infected and HIV/HCV-co-infected veterans.

OBJECTIVES: To determine the prevalence of hepatitis C virus (HCV) co-infection among HIV-infected veterans, assess the prevalence of comorbid conditions that may complicate or limit treatment options, and ascertain whether comorbid conditions were more common in co-infected veterans. DESIGN AND METHODS: We used the Veterans Administration electronic medical records system to identify all veterans receiving care for HIV during fiscal years 1997-2002. Demographic data and diagnostic codes for HIV, HCV, and comorbid conditions were extracted. The validity of using diagnostic codes was assessed by calculating the agreement between chart extraction and electronic data on a separate sample of veterans. Factor analysis was used to identify the structure underlying the intercorrelation between comorbid conditions. Logistic regression was used to compare the prevalence of comorbid conditions and factors between HIV/HCV-co-infected and HIV-mono-infected veterans, adjusting for age and race. RESULTS: We identified 25,116 HIV-infected veterans in care, of whom 4489 (18%) were HCV co-infected. A validity assessment revealed moderate agreement between chart extraction and electronic data for each of the comorbid conditions assessed. HIV/HCV-co-infected veterans were significantly more likely to have each of the comorbid conditions, and to have significantly more comorbid conditions. Factor analysis revealed three dimensions of comorbidity: mental disorders, medical disorders, and alcohol-related complications. Veterans with co-infection were significantly more likely to have mental disorders and alcohol-related complications. CONCLUSIONS: HIV/HCV-co-infected veterans had a higher prevalence of comorbid conditions that may complicate and limit treatment options for HIV and for HCV co-infection. Strategies to improve treatment options for co-infected patients with comorbidities must be developed.

Adolescent↗