RESUMEN
The wounding potential of a projectile depends on its kinetic energy. The aim of the study was to investigate the deceleration of non-deforming full metal jacket handgun bullets (FMJ) in gelatine blocks of increasing length. The temporary cavity (TC) was visualized using a SA-X2 Photron camera. 126 test shots in 9â¯mm nominal calibre were fired under strict temperature control conditions (4°C) at small gelatine blocks ranging from 2 to 12â¯cm in length. The deposited energy was calculated based on the loss of bullet velocity through high-speed video analysis. The length of the TC was measured, when the TC reached its maximum height. The volume of the TC was approximated by a cylinder. Regression analysis showed a linear correlation between the length of the bullet path and the energy transfer. The constant deceleration of the FMJ bullets in gelatine up to 12â¯cm bullet path was confirmed across various brands and velocity ranges (270-450â¯m/s). Higher impact velocities correlated with increased loss of energy in the target medium. The shape of the bullet tip influenced the characteristic of deceleration. The volume of the tubular temporary cavity, derived from high-speed video records, was found to be proportional to the energy transferred. The proposed approach might be a valuable tool in advancing wound ballistics research.
RESUMEN
We report on a four-year-old girl who suffered a complex mincer injury to the left hand, resulting in a partial amputation of her hand. To salvage the injured hand, revascularization was performed. The indication, advantages and outcome of the procedure are discussed.
Asunto(s)
Falanges de los Dedos de la Mano/irrigación sanguínea , Traumatismos de la Mano/cirugía , Traumatismo Múltiple , Reimplantación/métodos , Preescolar , Femenino , Falanges de los Dedos de la Mano/fisiopatología , Estudios de Seguimiento , Fijación de Fractura/métodos , Humanos , Rango del Movimiento ArticularRESUMEN
OBJECTIVE: The purpose of this study was to investigate whether in vitro cultured tracheal epithelial cells can be transplanted onto a prefabricated capsule surface in vivo for possible use in tracheal reconstruction. METHODS: Tracheal epithelial cells from 12 donor inbred rats were harvested for culture and expansion. In 16 recipient inbred rats, 2 sterile cylinders made of silicone rubber were implanted in each rat bilaterally in the folds of both the left and right anterior rectus sheath by wrapping the sheaths around the cylinders to induce a capsule formation. Ten days later, the cell cultures were divided and suspended in 1 of 2 delivery vehicles (standard culture medium or fibrin glue) and implanted onto the capsule surface. To compare the 2 delivery vehicles, we used fibrin glue on one side and the standard culture medium on the other. RESULTS: After 2 (group 1, n = 8) and 4 (group 2, n = 8) weeks, histologic findings, immunohistochemical staining, and electron microscopy demonstrated the capsule to be covered with a tracheal neoepithelium in group 1 and additional ciliated cells and secretory cells in a confluent layer in group 2 but only on the side with fibrin glue as the delivery vehicle. No viable epithelial cells were identified on the side with the standard culture medium in either group. CONCLUSION: We conclude that cultured epithelial cells can be successfully transplanted onto a prefabricated capsule surface with fibrin glue, which will differentiate into morphologic, nearly normal epithelium, showing potential for tracheal reconstruction.
Asunto(s)
Cápsulas , Trasplante de Células/métodos , Células Epiteliales/trasplante , Adhesivo de Tejido de Fibrina , Tráquea/trasplante , Enfermedades de la Tráquea/patología , Animales , Células Cultivadas , Sistemas de Liberación de Medicamentos , Masculino , Modelos Animales , Ratas , Ratas Wistar , Procedimientos de Cirugía Plástica , Sensibilidad y Especificidad , Siliconas , Propiedades de Superficie , Enfermedades de la Tráquea/cirugíaRESUMEN
BACKGROUND: Vertical banded gastroplasty (VBG) causes weight loss, which is often associated with redundant abdominal tissue. This redundant tissue can be used successfully for breast reconstruction or breast augmentation in case of mastectomy or ptotic hypotrophic breasts. METHOD: One patient with bilateral mastectomy is described in whom the weight fell from BMI 52 to BMI 26 after VBG, giving the patient an abdominal "apron", which facilitated bilateral breast reconstruction. RESULTS: Bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction after weight reduction following VBG resulted in an esthetic pleasing result with additional correction of the cutis laxa abdominis. CONCLUSION: Autologous breast reconstruction can be performed safely with the methods used today, after successful weight loss following obesity surgery.
Asunto(s)
Gastroplastia , Mamoplastia , Obesidad Mórbida/cirugía , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/epidemiología , Carcinoma Ductal de Mama/cirugía , Comorbilidad , Femenino , Humanos , Persona de Mediana Edad , Obesidad Mórbida/epidemiologíaRESUMEN
The purpose of the study was to transplant autologous cultured urothelial cells onto a muscle via fibrin glue as a delivery vehicle to create a vascularized, living matrix lined with urothelium that could subsequently be used for urinary reconstruction. Bladder tissue specimens from male Wistar rats (n = 32; 350--500 g) were harvested for urothelial tissue culture. After 8--10 days when the primary cultures became confluent, the cultured urothelial cells were injected underneath the rectus sheath onto the rectus muscle. As delivery vehicle we compared standard culture media and fibrin glue. At 1- and 4-week intervals following urothelial cell grafting, sections of the muscle were analyzed for urothelial graft take using Hematoxylin & Eosin and immunohistochemical staining. The histology demonstrated viable, multilayered clusters of urothelium cells on the muscle surface only in the group using the fibrin glue delivery vehicle. We conclude that a muscle can be successfully prelaminated with autologously cultured urothelial cells via fibrin glue and has therefore potential for urinary reconstructions.
Asunto(s)
Trasplante de Células , Adhesivo de Tejido de Fibrina , Recto del Abdomen/cirugía , Urotelio/citología , Urotelio/trasplante , Animales , Células Cultivadas , Medios de Cultivo , Técnica del Anticuerpo Fluorescente Directa , Inmunohistoquímica , Masculino , Ratas , Ratas WistarRESUMEN
BACKGROUND: Different methods for managing pilonidal disease have been described in the literature. Recurrence impairs the success of all forms of therapy, but the lowest rates have been reported for reconstructions involving local flaps. Nevertheless, treatment of pilonidal disease with a fasciocutaneous V-Y flap is not a well-established procedure. We have modified the surgical technique and used it selectively for complicated recurrent cases. Our experience with this method is analyzed, and its validity is evaluated. METHODS: Twenty-four patients with recurrent pilonidal sinus undergoing radical excision and reconstruction with our modified fasciocutaneous V-Y advancement flap between 1986 and 1993 were studied retrospectively. RESULTS: Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Furthermore, an excellent functional result and acceptable scar pattern were obtained in all twenty-four patients, with a mean follow-up of 4.5 years. Neither evidence of recurrence nor impairment of daily life activity was noted. CONCLUSIONS: Treatment of complicated recurrent pilonidal sinus with the described technique offers a safe but demanding method for definite reconstruction, and we support a more common application.
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Seno Pilonidal/cirugía , Colgajos Quirúrgicos/métodos , Adolescente , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Seno Pilonidal/fisiopatología , RecurrenciaRESUMEN
The symptomatic effects of oxygen on the dyspnea of terminally ill cancer patients have not been clearly established. Therefore, the decision to administer oxygen is frequently made on an individual basis. We report on the use of N of 1 randomized clinical trial to compare the symptomatic benefit of respiratory failure due to terminal ovarian cancer. A 53-yr-old female patient underwent 6 randomized double-blind crossover trials between oxygen 5 L/min delivered by mask and air 5 L/min delivered by mask. Each treatment period lasted 5 min. The mean saturation of oxygen during the baseline period was 84% +/- 3%, versus 84% +/- 4% on air (P,NS) and 94% +/- 4% on oxygen (P less than 0.001). The mean visual analogue scale (VAS) for dyspnea was 77 +/- 4 during the baseline period as compared to 51 +/- 7 after air (P less than 0.001), and 40 +/- 5 after oxygen (P less than 0.001). The patient and the investigator chose oxygen blindly in 5 of 5 cases, air in 0 and 1 case, and no choice was made in 1 and 0 case, respectively. In 4 cases the patient considered the difference between oxygen and air to be of "much importance," and in one case to be of "moderate importance." No significant treatment, period, or interaction between period and treatment was detected for the difference in the VAS. We conclude that oxygen was significantly better than air for symptomatic improvement in this patient. The N of 1 technique is a simple and reliable method for the assessment of individual patients' response to oxygen.
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Hipoxia/terapia , Neoplasias Ováricas/complicaciones , Terapia por Inhalación de Oxígeno/normas , Análisis de los Gases de la Sangre , Femenino , Humanos , Hipoxia/sangre , Hipoxia/etiología , Persona de Mediana Edad , Cuidado TerminalRESUMEN
In a prospective, open study, 78 patients with terminal cancer received proctoclysis (rectal hydration) in four different centers. In all cases, a #22 French nasogastric catheter was inserted approximately 40 cm into the rectum and an infusion of normal saline (2 cases) or tap water (76 cases) was administered at a rate of 250 +/- 63 cc/hr. Hydration was maintained for 15 +/- 8 days. The main reason for discontinuation of hydration was death (60 cases). The mean visual analogue score for discomfort after infusion (0 = no discomfort, 100 = worst possible discomfort) was 19 +/- 14. The costs of proctoclysis was estimated at Can$0.08 compared with Can$4.56 per day for hypodermoclysis, and Can$2.78 per day for intravenous hydration. Our results suggest that proctoclysis is a safe, effective, and low-cost technique for the delivery of hydration in terminally ill cancer patients.
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Fluidoterapia/métodos , Neoplasias/complicaciones , Cuidado Terminal , Administración Rectal , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Two hundred and seventy-seven patients were admitted to this prospective multicenter study in order to assess the accuracy of a staging system for cancer pain. The staging system (SS) was completed by a trained physician during the initial consultation. This system included the assessment of pain mechanism (PM, neuropathic versus nonneuropathic), pain characteristic (PC, continuous versus incidental), previous opioid dose (OD), cognitive function (CF), psychological distress (PD), tolerance (T), past history of alcohol or drugs (A). During day 21, a final assessment of pain control was made. Agreement for staging was observed in 96% of cases for investigators 1 and 2 (kappa 0.76, P < 0.001), and in 84% of cases between investigators 1 and 3 (kappa 0.723, P < 0.001). Of 276 evaluable patients, 86/92 Stage I (good prognosis) patients achieved good PC (93%) versus 102/184 Stage II and III (poor prognosis) patients (55%, P < 0.001). Sensitivity and specificity of the system were found to be 0.93 and 0.46, respectively. Univariate correlation found significant correlation between pain control and all variables except CF. In logistic regression, CF and OD showed no significant correlation. We, therefore, propose a more simple SS of five categories (PM, PC, PD, T, and A) and two stages (good and poor prognosis). We conclude that the SS is highly accurate in predicting patients with good prognosis, but patients with "poor prognosis" can still achieve good pain control in more than 50% of cases.
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Neoplasias/complicaciones , Dimensión del Dolor/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Cuidados Paliativos/métodos , Analgésicos Opioides/economía , Brasil , Costos de los Medicamentos , Utilización de Medicamentos , Organización Mundial de la SaludRESUMEN
The World Health Organization (WHO) has indicated that opioid analgesics are insufficiently available, particularly in developing countries, due to a variety of reasons, including legislative, educational, and policy issues. In its effort to promote the rational use of medical opioids and the adequate treatment of patients with cancer, WHO has sponsored a meeting of Latin American representatives every 2 years, which includes health professionals and government regulators. During March 24-27, 1996, a group of 86 representatives of cancer pain relief and palliative care programs from nine Latin American countries met in Santo Domingo under the auspices of the WHO Palliative Care Program for Latin America. For the first time since the First Latin American Meeting, government regulators were present to help address the issue of opioid availability from their perspective. During the meeting, issues pertaining to cancer pain, opioid availability, and palliative care were discussed. This report summarizes some of the events and presents a summary of the conclusions of an earlier meeting in 1994, as described in the Declaration of Florianopolis, and presents its follow-up, The Santo Domingo Report, generated following the 1996 meeting.
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Analgésicos Opioides , Accesibilidad a los Servicios de Salud , Control de Medicamentos y Narcóticos , América Latina , Legislación de MedicamentosRESUMEN
Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. The fistulae can be difficult to treat, and several techniques, both operative and nonoperative, are advocated. We present a simple technique for the treatment of chronic thoracic duct fistula where other procedures have failed. After identification and ligation of the duct, the area is covered with the clavicular head of the sternocleidomastoid muscle.
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Fístula/cirugía , Músculo Esquelético/trasplante , Procedimientos de Cirugía Plástica/métodos , Conducto Torácico/cirugía , Enfermedad Crónica , Femenino , Fístula/patología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Conducto Torácico/patologíaRESUMEN
Breast-conserving therapy, which aims to reduce trauma by preserving as much of a patient's natural appearance as possible, does not necessarily lead to an optimal cosmesis. We hypothesized that combining plastic and oncologic surgeries would greatly reduce the physical and psychological traumas and produce an optimal cosmesis without impairing the oncologic outcome. We performed breast reconstruction on 40 cancer patients. Of those 40 patients, 15 received combined plastic and oncologic surgeries. Procedures depended on breast size: mammareduction plasty in cases with sufficient volume, and reconstruction using myocutaneous latissimus dorsi flaps for those with less volume. Cosmetic results were rated good to poor. Of the 15 primary reconstruction patients, 86.7 percent of the cases showed good results and 13.3 percent fair; in the secondary cases, 68 percent were good, 16 percent fair, and 16 percent poor. Through a follow-up and cosmetic evaluations by both surgeons and patients, the study showed that combining aesthetic improvements and oncologic surgery does not compromise patient safety, reduces mental and physical trauma, and frequently results in superior cosmesis, thereby improving the patient's overall health.
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Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Adulto , Carcinoma Ductal de Mama/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Mastectomía Segmentaria , Reoperación , Colgajos QuirúrgicosRESUMEN
The most visible scar in the conventional abdominoplasty procedure or TRAM flap donor site closure is the scar around the reinserted umbilicus. In an attempt to increase the aesthetic outcome, the authors have introduced a new technique of umbilical reconstruction and reinsertion during abdominoplasty avoiding any paraumbilical scar, which results in a more natural appearance in that area. This new technique, potential pitfalls, and long-term results are reported.
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Abdomen/cirugía , Ombligo/cirugía , Femenino , Humanos , Masculino , Colgajos Quirúrgicos , Técnicas de SuturaRESUMEN
Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to achieve bone union and to restore the scaphoid. Many procedures are described to treat scaphoid nonunion for different indications. This retrospective study reports on the anatomical fundamentals, the operative procedure, and the results of 60 patients (21 with recalcitrant scaphoid nonunion that lasted longer than 4 years, 26 with an avascular pole fragment, and 13 with scaphoid nonunion after previous surgery) who were treated by a small free vascularized iliac crest bone graft. All 60 patients have routinely been followed up clinically and with magnetic resonance imaging. Union was achieved in 91.7 percent by improvement of stability and the compromised vascularity of the scaphoid. The bone flap loss rate and persisting nonunion was 8.3 percent, leading to progressive arthritis and carpal collapse. Complaints concerning discomforts caused by the scar were heard from 40.1 percent of the patients, and 31.7 percent complained of discomforts caused by the bony deformity. Bone deformations on the donor site were detected radiologically in 63.3 percent of the patients. In 31.7 percent, an impairment of the lateral femoral cutaneous nerve was noted. Reconstruction of the scaphoid by means of implantation of a vascularized iliac bone graft proved efficient to treat avascular recalcitrant scaphoid nonunion and pseudarthrosis with avascular proximal pole fragments.
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Trasplante Óseo/métodos , Hueso Escafoides/cirugía , Adolescente , Adulto , Femenino , Humanos , Ilion , Masculino , Persona de Mediana Edad , Osteoartritis/etiología , Complicaciones Posoperatorias , Estudios Retrospectivos , Hueso Escafoides/anatomía & histología , Resultado del TratamientoRESUMEN
The concept of emergency free tissue transfer for severe extremity injuries represents a cutting-edge technology. We discuss our very positive results with this technique. The conceptual reasons for these favorable results, compared with conventional approaches, are also discussed. An initial, radical debridement is the most important part of the operation. This is then followed by osteosynthesis. The correct type of free tissue transfer is chosen according to the requirements of the soft tissue defect. Qualitatively better results with earlier definitive rehabilitation were achieved with free tissue transfer performed during the acute stage of limb wound treatment. The follow-up period ranged from 3 months to 8 years. We experienced neither flap loss, osteomyelitis, nor severe wound infection. Using the modern concept of emergency free tissue transfer, we reduced the rate of flap loss and associated morbidity while achieving a functionally improved reconstruction.
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Traumatismos del Brazo/cirugía , Traumatismos de la Pierna/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos , Infección de Heridas/prevención & control , Adolescente , Adulto , Anciano , Amputación Traumática/cirugía , Niño , Preescolar , Desbridamiento , Urgencias Médicas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: The coverage of recurrent pressure sores with unstable scar in the surrounding tissue is still an unsolved problem in the literature. Local and regional transfer of tissue often does not meet the requirements of the tissue deficit. Especially in recurrent pressure sores, the adjacent skin has already been consumed due to multiple surgeries. As a good alternative, the microsurgical transfer of flaps offers viable tissue to cover even large pressure sores. METHODS: We performed a total of six free flaps in five patients who suffered from intractable pressure sores in the hip region. The age of the patients was between 41 and 63 years. The defect size varied between 6 x 6 cm and 25 x 30 cm. Two combined myocutaneous scapula-latissimus dorsi, two myocutaneous latissimus dorsi, one anteromedial thigh, and one rectus femoris flap were used to cover the defects. RESULTS: The average follow-up time was 29 months. Flaps provided stable coverage in four of five patients at 12-month follow-up. There was one subtotal flap necrosis that was subsequently treated with split-thickness skin grafting. CONCLUSION: In this series of five patients with six free flaps, we were able to show that the microsurgical transfer of tissue is a valuable option in the treatment of difficult pressure sores. Even in older and debilitated patients, this method is a good alternative to conventional local flaps.
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Microcirugia/métodos , Complicaciones Posoperatorias/cirugía , Úlcera por Presión/cirugía , Colgajos Quirúrgicos , Adulto , Femenino , Estudios de Seguimiento , Talón/cirugía , Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Reoperación , Sacro/cirugíaRESUMEN
At the beginning of the sixties the injection of liquid silicon oil was frequently used for breast augmentation. It was thought to be safe, simple and effective. But as complications such as local silconomas, inflammatory reactions, induration, foreign body extrusion and foreign body migration were published this procedure was not used anymore. We report about a 45-year-old female patient who suffered from late complications, chronic recurrent local destructive siliconomas, which have not been described in the literature yet. Because of the destruction forced by the primary silicone implant a bilateral subcutaneous mastectomy had to be performed and siliconomas were excised at regions different from the original injection site. Several breast reconstructions have been performed but this tissue has also been destroyed by the recurrent and aggressive siliconomas. As there can be a long period of latency before the aforementioned complications of liquid silicon injections can occur, we recommend careful follow-up for these patients.
Asunto(s)
Enfermedades de la Mama/cirugía , Implantes de Mama , Granuloma de Cuerpo Extraño/cirugía , Mamoplastia , Aceites de Silicona/efectos adversos , Silicosis/cirugía , Mama/patología , Mama/cirugía , Enfermedades de la Mama/patología , Enfermedad Crónica , Femenino , Granuloma de Cuerpo Extraño/patología , Humanos , Inyecciones , Ganglios Linfáticos/patología , Persona de Mediana Edad , Recurrencia , Reoperación , Aceites de Silicona/administración & dosificación , Silicosis/patologíaRESUMEN
Between 1980 and 1995, 207 patients with 219 extensive pelvic pressure sores underwent reconstructive surgery at our department. Eighty patients operated upon between 1992 and 1995 were followed up. The postoperative complication rate was 22% and the relapse rate 27%. Pre- and postoperative management has been standardized for the purposes of quality control. The value of preoperative management, choice of flap, operative procedure and postoperative care are discussed in this paper.
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Desbridamiento/instrumentación , Úlcera por Presión/cirugía , Succión/instrumentación , Colgajos Quirúrgicos/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Garantía de la Calidad de Atención de Salud , Cicatrización de Heridas/fisiologíaRESUMEN
We report on a 19-year-old male patient with partial destruction of the index metacarpophalangeal joint due to traumatic middle hand amputation. Six months after replantation the metacarpophalangeal joint defect was reconstructed with an osteochondral metatarsal head graft from the second metatarsophalangeal joint. At a follow-up period of four years the patient achieved full metacarpophalangeal extension, with 40 degrees of flexion and grip strength equal to 90 % of the contralateral index finger. Magnetic resonance imaging showed enhancement of contrast medium as a sign for vitality of the transplant.