Norman S. Levine

The Quantitative Swab Culture And Smear: A Quick, Simple Method For Determining The Number Of Viable Aerobic Bacteria On Open Wounds

The quantitative swab culture is a reliable method for quantifying the number of viable bacteria colonizing open wounds. For open wounds in burn patients, the swab bacterial count is linearly related to biopsy quantification of viable bacteria in the underlying tissue. This technique is simple and requires no surgical manipulation of the wound. For a wound of uniform appearance, the standard deviation of a single swab culture from the mean log bacterial count for a series of cultures from widely spaced areas on the wound is +/- 0.85 logs; 95% confidence limits are +/- 1.7 logs from the mean. A Gram-stained smear from a wound swab requires less than 10 minutes to prepare. Visualization of bacteria on the smear indicates that 106 or more bacteria per swab are present. The value of the smear and swab techniques for predicting safe wound closure may be inferred from the published reports of others and the direct relationship between the swab and biopsy counts of viable bacteria for open wounds.

Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep.

The effect of von Langenbeck palatoplasty and pharyngeal flap surgery on upper airway obstruction during sleep was studied by obtaining polysomnographic sleep studies on 10 patients undergoing each procedure at 1 to 2 days prior to surgery, 2 to 3 days postoperatively, and approximately 3 months postoperatively. The effects of von Langenbeck palatoplasty on sleep-related upper airway obstruction were usually minimal and clinically insignificant, whereas severe obstructive sleep apnea was present in all but one of the patients undergoing pharyngeal flap surgery at 2 to 3 days postoperatively. In most patients the upper airway obstruction was resolved at the 3-month postoperative sleep study. These data suggest that palatoplasty carries with it a very slight risk of upper airway obstruction, whereas pharyngeal flap surgery has as a very frequent concomitant the occurrence of severe obstructive sleep apnea in the immediate postoperative period.

Inhibitory action of vitamin A on a murine sarcoma.

Abstract High doses of vitamin A decrease the incidence and severity of tumor development in mice inoculated with a murine sarcoma virus.

Blood Pressure Drop as a Result of Fluorescein Injection

: Our experience with intravenous fluorescein involved 38 administrations in 29 patients. In all, 24 percent were associated with a drop in blood pressure of 20 mmHg or more and 8 percent with a blood pressure fall of 60 mmHg or more. We believe that physicians using fluorescein in bolus form should be aware of the problem of blood pressure reduction and be prepared to take restorative measures when necessary.

EVALUATION OF DIGITAL ESCHAROTOMY IN BURNED HANDS

A controlled study of digital escharotomy showed a statistically significant increase in the number of salvaged phalanges. This procedure has minimal risk and should be considered in patients with vascular compromise of the upper extremity requiring escharotomy, who also have circumferentially burned fingers.

Completely embedded ring in the finger of a growing child

A case of a completely embedded ring in the finger of a growing child is presented. Because the ring was completely covered with epithelium or eschar, the diagnosis was masked until radiographs were obtained. Although bony erosion was present, neither digital sensation nor circulation was compromised. The patient regained nearly full, active motion after the ring was removed.

THE EFFECT OF EARLY SURGICAL EXCISION AND HOMOGRAFTING ON SURVIVAL OF BURNED RATS AND OF INTRAPERITONEALLY-INFECTED BURNED RATS

The effects of early and delayed surgical excision and skin homografting on survival in burned, uninfected rats and in burned rats infected with Pseudomonas aeruginosa, intraperitoneally, has been studied. The survival rate in animals treated with surgical excision and no coverage was significantly worse than in the animals who were simply burned. Immediate excision of the burn wound followed by prompt coverage with skin homografts resulted in decrease in the mortality rate from subsequent intraperitoneal infection of Pseudomonas. The beneficial effects of early surgical excisions and immediate skin homograft coverage were also achieved when formalin-fixed skin homografts were used.

Laser, scalpel, electrosurgical, and tangential excisions of third degree burns. A preliminary report.

Our clinical experience with laser, electrosurgical, scalpel, and tangential burn wound excisions in 26 patients is presented.

The shutter flap for large defects of the forehead

Acquired defects involving exposed bone in the central forehead can be challenging to reconstruct. We present a simple technique in which two superiorly based flaps of galea frontalis and skin are transposed medially, like the shutter of a camera. Full-thickness grafts are used to close the donor site. This is a remarkably easy way to close some very large forehead wounds.

Musculoskeletal surgery for cancer : principles and techniques

Surgical treatment of soft tissue sarcomas of the extremities osteogenic sarcoma staging, pathology, and radiology of musculoskeletal tumours rehabilitation of patients with extremity sarcoma phantom limb pain combined wide local excision plus high-dose radiation for sarcoma induction chemotherapy for sarcomas of the extremities posterior flap hemipelvectomy anterior flap hemipelvectomy internal hemipelvectomy the abdominoinguinal incision for the resection of pelvic tumour buttockectomy summary of alternative approaches to hemipelvectomy hip disarticulation sacrectomy above-knee amputation distal femoral resection for sarcomas of bone below-knee amputation limb-sparing surgery for malignant tumours of the proximal tibia adductor muscle group excision quadriceps muscle group excision resection of the posterior compartment of the thigh forequarter amputation radical forequarter amputation with chest wall resection above-elbow amputation scapulectomy - type III shoulder girdle resection shoulder girdle resections - the Tikhoff-Linberg procedure and its modifications summary of alternative approaches to forequarter amputation below-elbow amputation the surgical treatment of metastatic bone disease.