Kenneth T. Bellian

Influence of knot configuration and tying technique on the mechanical performance of sutures

The purpose of this investigation was to determine the influence of knot configuration and tying technique on the mechanical performance of surgical sutures. Multifilament and monofilament nylon sutures were selected for this evaluation because they are commonly used in wound closure. The mechanical performance of these sutures was judged by the following parameters: knot breakage force, configuration of secure knots, and knot run down force. During each test, tension was applied at either rapid or slow rates, which correlates with the physicians speed of tying knots. On the basis of these mechanical performance tests, four throw square (1 = 1 = 1 =1) knots and five throw square (1 = 1 = 1 = 1 = 1) knots are recommended for monofilament nylon and multifilament nylon sutures, respectively, in which the speed of application of forces to the knots is relatively slow. Because these tests can easily be replicated in any laboratory, manufacturers now have a scientific basis for recommending specific tying techniques for their surgical sutures.

Toxic shock syndrome after functional endonasal sinus surgery: An all or none phenomenon?

Reported cases of toxic shock syndrome (TSS) following nasal surgery or functional endonasal sinus surgery (FESS) are uncommon. Classic TSS is a serious multisystem disorder resulting from Staphylococcus aureus phage I toxic shock syndrome toxin 1 (TSST‐1), and it is characterized by fever, rash, hypotension, mucosal hyperemia, vomiting, diarrhea, and laboratory evidence of multisystem organ dysfunction. TSS cases following nasal surgery have been associated with nasal packing, mucosal barrier violation, prior S aureus phage I colonization, as well as low antitoxin antibody levels.1

Damage to tissue defenses by EMLA® cream☆

EMLA is a new topical agent that safely anesthetizes intact skin. The purpose of this study was to determine if this cream could be safely used for anesthetizing wounds. This investigation evaluated the potential toxicity of EMLA cream in wounds by measuring its effect on host defenses and on the biology of wound repair. In contaminated wounds, EMLA cream elicited an exaggerated inflammatory response that damaged host defenses, inviting the development of infection. As a result of these investigations, we do not recommend the use of EMLA cream in wounds.

Electrical burn injuries of workers using portable aluminium ladders near overhead power lines.

The use of aluminium ladders around high voltage power lines has resulted in a significant number of electrical injuries and electrocutions. Workers often misjudge wire distances or lose control of fully extended ladders, thereby exposing themselves to electrocution hazard. High-voltage electrical burns of two workers using an aluminium ladder that contacted a high voltage power line are reported. The circumstances surrounding the injury, the clinical management of the case, and the methods of prevention are presented and discussed.

Computer analysis of the performance of the BTE work simulator

The BTE Work Simulator (Baltimore, Therapeutic Equipment Co., Hanover, Md.) recreates the work environment by providing a rotatable shaft to which a variety of tools can be attached. The patient can simulate the coordinated muscle and joint movements involved in the work situation, exercising either isometrically or isotonically, and thereby increase the potential for return to work. The BTE Work Simulator has four major components: the exercise head to provide variable resistance, tools that attach to the exercise head, a control console containing a microprocessor that calculates work and power, and the Quest software package (Baltimore Therapeutic Equipment Co.). Quest provides four static/isometric and seven dynamic/isotonic tests that can be used to document the extent of a patients impairment. In addition, it has daily treatment options and acts as an extensive data base capable of retrieving any stored test or treatment results. This software system greatly facilitates the use of the BTE Work Simulator by providing instant calculations of power and coefficients of variation, immediate patient feedback, graphic expansion of the data, and printed evaluation reports.

Otolaryngology Care Unit: A Safe and Cost‐Reducing Way to Deliver Quality Care

Objectives: Patients undergoing treatment for head and neck cancer, obstructive sleep apnea, and potential airway obstruction are often unnecessarily admitted to an intensive care unit (ICU). This study determined the efficacy of an intermediate care unit (OtoCare Unit) for their management.

Adaptive communication systems for patients with mobility disorders

An adaptive communication system has been developed for individuals with mobility disorders. It uses specialized computer software and hardware that compensate for this disability. For an individual with a motor-control impairment who is not able to use a keyboard effectively, a computer voice-recognition technology now removes this communication barrier. Speech-recognition systems consist of three basic components: speech processing, speech recognition, and speech understanding. The new Dragon Dictate (Dragon Systems, Inc., Newton, Mass.) is the first large-vocabulary speech recognition system in the personal computer industry that interactively learns a users vocabulary and mode of speaking and responds to natural language rather than to limited sets of words. This speech-recognition system requires a microprocessor, a display monitor, a printer, and specific software packages, including word-processing and enhanced memory-management software. Important considerations in the use of this speech-recognition system include microphone positioning and training of the system. With the advent of this new voice-recognition computer system, another communication barrier between the disabled and society has been overcome.

CONCURRENCE OF MULTIPLE SCLEROSIS AND HODGKIN'S DISEASE

Although multiple sclerosis and Hodgkins disease are reported to have similar epidemiologic features, this is only the first case report in which there was concurrence of these diseases. Fourteen years after successful treatment of Hodgkins disease, this 31-year-old white male developed multiple sclerosis. The diagnosis of multiple sclerosis was made on the basis of clinical and paraclinical findings that were characteristic of multiple sclerosis. In addition, specific tests were performed to rule out a variety of infectious, metabolic, and neoplastic diseases that simulate multiple sclerosis.

A new compound-curved needle for microvascular surgery

A new compound-curved needle has been designed and developed for microvascular surgery from a unique stainless steel alloy, American Society for Testing Materials 45500. This needle has two distinct radii of curvature and a short tapered point, followed by a curved distal section. Despite its geometry, it exhibits similar resistance to bending and breakage as a curved needle with a single radius of curvature manufactured from the same alloy. The design of this new needle enables plastic surgeons to pass it through vessel walls with greater accuracy to a controlled depth and length of bite than a curved needle with a single radius of curvature.

Model rocket engine burn injuries: The need for stricter regulation

During the 18-year period from 1975 to 1992, the Consumer Product Safety Commissions National Electronic Injury Surveillance System database received reports of 18 burn injuries caused by model rocketry sets and their engines. Children in the age range of 11 to 15 years, who frequently use the products inappropriately, are the pediatric population most at risk. Unfortunately, current regulations do not impose age restrictions on the purchase or use of these products; consequently, the industry sets its own age limits. The current regulations appear to be inadequate and need to be altered to cover the population at risk. Specific recommendations include imposing an adequate age limit and improving the labelling of these products. Two case reports are presented that exemplify the typical burn injuries sustained from model rocket engine accidents.