The physician cost of treating maxillofacial trauma

Treatment of maxillofacial trauma patients can be difficult for the surgeon because of patient noncompliance, frequent litigation, and poor payment habits. Numerous studies have examined the socioeconomic aspects of trauma as they affect hospitals and communities, but none to date has looked at the socioeconomic aspects of trauma as they affect the surgeon. This study is based on a retrospective sequential review of the medical records of 50 patients who suffered malar complex fractures and were treated with operative reduction at a university medical center. These patients are compared with a sequential series of 20 patients with basal cell carcinoma of the cheek treated by the same surgeon. The maxillofacial trauma group paid an average of 57 percent of their bills and had cases that involved lawyers 30 percent of the time, and only 54 percent of the patients kept all their postoperative appointments. All these figures were statistically different from those of the basal cell carcinoma patients, who paid an average of 90 percent of their bills and had no cases that involved lawyers and 95 percent of whom kept all postoperative appointments. These findings support the premise that maxillofacial trauma patients are difficult patients to treat and that unless the trauma reimbursement system is revised, plastic surgeons may limit their treatment of trauma in the future.     

液压伺服阀的降本维护

本文主要以日照钢铁带钢厂精轧机AGC电液伺服阀的特色维护为例,介绍了工作环境对伺服阀的影响,并采取相应的改进措施;对伺服阀参数进行调整。保障了伺服阀的稳定性、精确性,对液压伺服控制系统故障的预防起到了一定作用,提高了伺服阀的使用寿命、降低了设备故障率和维护成本。     

The economics of treating tibia fractures. The cost of delayed unions

We cloned a gene (topA) encoding DNA topoisomerase II from Dictyostelium discoideum nuclear DNA using oligo probes corresponding to the consensus amino acid sequences found in the gene in other eukaryotes. The gene encoding a predicted polypeptide of 1282 amino acids with M(r) of about 146 kDa, is a single copy that is expressed as a polyadenylated 4.5 kb RNA. The predicted amino acid sequence shares similarity with those of other eukaryotes with identity between 32 and 46%. The protein is 260-300 amino acids shorter in the C-terminal region and 50-80 longer in the N-terminal region than those of other eukaryotes. In TopA of D. discoideum, the N-terminal region with stretches of charged and hydrophilic amino acids is predicted to fold into an amphiphilic alpha-helix which is characteristic of a mitochondrial targeting signal presequence. Four independent polyclonal antibodies against bacterially expressed GST fusion proteins containing four portions of the polypeptide detected a single band on Western blots at about 135 kDa. Western blots analysis of subcellular fractions revealed that this protein is localized in mitochondria. The protein and the mRNA are present in growth phase and during development, although levels of both declined as development proceeded.     

The link between drug use and heart valve disease

We report MRI and angiographic findings of an unusual giant arachnoid granulation in the left sigmoid sinus in a boy with headache. Its signal intensity was lower than that of cerebral cortex on T1-weighted images and higher on T2 weighting, mimicking dural sinus thrombosis.     

Evaluation of prosthetic valve function and associated complications

Significant advances in imaging modalities have occurred to evaluate prosthetic valve function and associated complications. These developments involve predominantly the introduction of Doppler technology for the non-invasive determination of gradients and valve areas and TEE for an improved assessment of valve structure, function, and associated complications. The current role of cinefluoroscopy is mostly to complement TEE in the evaluation of motion of mechanical prosthetic valves in the aortic position. Cardiac catheterization is now rarely needed to assess valve function. Diagnosis of prosthetic valve obstruction can be performed in the majority of cases with transthoracic Doppler echocardiography. Differentiation of valve obstruction from normal valve function in small valves with high flow conditions, however, may be difficult. Because of this and the variability in normal valves among different prostheses, knowledge of the type and size of the implanted valve is essential. Patients and ultrasound laboratories are encouraged to seek and provide this information on a routine basis. Although transthoracic echocardiography is the main diagnostic modality for the serial evaluation of prosthetic valve function, it is important to recognize its limitations in assessing prosthetic mitral regurgitation and evaluating structural abnormalities of prosthetic valves. These are the situations in which TEE has the most impact. A summary of general indications of TEE in prosthetic valves is provided in Table 6. Finally, a baseline transthoracic Doppler study is essential in the overall follow-up and serial evaluation of valve function. For future comparisons, the best indices of valve functions are those obtained for patients as their own control, from a baseline Doppler echocardiographic study performed early after the operation.     

Choosing a prosthetic heart valve

Although most of the available prosthetic heart valves function remarkably well, the variety of available choices attests to the inability of any single one to fulfill the requirements of the ideal valve substitute. The mechanical prostheses include the caged-ball, tilting-disc, and bileaflet valves. Tissue valves available in the United States are the Carpentier-Edwards and Hancock porcine heterograft valves and the Carpentier-Edwards pericardial valve. Review of several large comparative studies on valve performance reveals that the overall results with tissue and mechanical valves are about equal at the end of 10 years. The characteristics of each type of valve substitute dictate the selection of one prosthesis in preference to others for a particular patient. Mechanical prostheses are recommended for patients without contraindications for anticoagulants. Tissue valves are reserved for patients over 65 years of age or for patients in whom anticoagulation is contraindicated. Multiple other patient-related factors need to be considered in selecting the appropriate valve, including the psychosocial situation and patient preference.     

Pulmonary complications after heart surgery

The authors present a detailed analysis of pulmonary complications after open-heart surgery and of their risk factors. The results of the presented study indicate that COPD patients with functional impairments are more sensitive to complicated postoperative outcome and to respiratory infections, in general. There is a clear relationship between artificial violation of the pleural cavity, diaphragmatic dysfunction and pleural effusion. Diaphragmatic dysfunction appears more frequently in mammarocoronary bypass patients in consequence of pleurotomy. The incidence of dysfunction could be reduced by the use of phrenic nerve insulation. Patients with pulmonary complications suffer from serious pulmonary function deficit. The possibilities of identification of the patients at risk, as well as the prevention and prophylaxis are analysed. (Tab. 7, Fig. 2, Ref. 71.)     

Infectious complications after heart surgery

In the paper the authors report their experience with the prophylaxis and treatment of infectious complications in 393 patients operated upon the heart. An increase of the specific weight of gram-negative bacteria as an etiological cause of infection and also the increase incidence of infection as the main or sole cause of mortality ill patients, operated upon under artifical circulation, were noted. Based on the study of various combinations of antibiotics against principal agents of surgical infection, it was found that a combination of bactericidal drugs such such as ampicillin with gentamycin or carbencillin with gentamycin proved to be the most effective and safe. Tetraolean was shown to be not effective enought against pyocyanic bacillus. Some information concerning the dosage and methods of using various antibiotics and their combinations for prophylaxis and treatment of suppurative complications is reported.     

Late treatment related complications of Hodgkin's disease

Patients cured of Hodgkin's disease are at high risk for developing late treatment-related complications. Radiation therapy is responsible for non malignant complications such as pulmonary, digestive, thyroid and cardiac toxicity. Chemotherapy is mainly responsible for pulmonary toxicity and gonadal dysfunction in females and in males, whatever the age at treatment. Hodgkin's disease therapy may also result in secondary malignancy which is considered the most serious complication. White the use of non leukaemogenic chemotherapy can limit the incidence of secondary leukaemia, that of secondary solid tumours is still increasing, being 15% after 20 years. Altogether, malignant and non malignant complications are still responsible for a non negligible overmortality.     

Chronicle of a defective heart valve prosthesis

The Bj?rk-Shiley convexo-concave (BScc) strut fracture problem is about to enter its third decade. At present, valve carriers still face the risk of outlet strut fracture; a risk which does not seem to decline. The temporising attitude of the manufacturer has led to far more victims than would have been necessary but also the Food and Drug Administration, regulatory agencies outside the US and the medical community share responsibility for this problem.     

Peripheral arterial complications after heart catheterization

After diagnostic and interventional cardiac catheterization, local vascular complications at the arterial entry site must be expected. With respect to the method applied for catheterization and the puncture site, the type of complications may vary. With transfemoral approach a large variety of vascular complications have to be feared, mostly in the form of bleeding complications and hematomas, arterial dissections or occlusions, pseudoaneurysms and AV-fistulas. Each of these complications may have the potential for serious morbidity. When cardiac catheterization is performed via the arteries of the arm (either in the classical Sones technique by arterial cutdown to the brachial artery or by direct puncture of the brachial or radial artery) vascular occlusions will mostly occur as local vascular complications. These occlusions can often be managed conservatively or by a surgical procedure. The incidence of a vascular complication is mainly dependent on patient-related (sex, age, height, weight, arterial hypertension, diabetes, presence of peripheral vascular disease and compliance of the patient after withdrawal of the sheath) and procedure-related (arterial access site, diagnostic or interventional study, sheath size, periprocedural anticoagulation, duration of intra-arterial sheath placement, faulty puncture technique, operator skill) factors. In addition, the definition of a complication, the publication year of a certain study and the technique used for identification of complications seem to play a role for the reported incidence of peripheral vascular complications after cardiac catheterization. Currently, incidences of 0.1 to 2% for significant local vascular complications after diagnostic transfemoral catheterization are reported, after interventional transfemoral treatment 0.5 to 5% and after complex procedures using large sheath sizes with periprocedural anticoagulation (directional atherectomy, IABP, left-heart assist, valvuloplasty) up to 14%. Following transbrachial and transradial catheterization, local vascular complications at the entry site amount to 1 to 3% after diagnostic and 1 to 5% after interventional procedures. Local vascular complications may be diminished by a cautious and sensitive puncture technique with additional care in patients at higher risk for vascular complications (females, prediagnosed peripheral vascular disease, mandatory anticoagulation, necessity for large sheaths). By using smaller sized catheters and an adequate, defensive anticoagulation regimen, the rate of arterial access site complications may be reduced. Proper methods for achievement of hemostasis as well as a close and careful observation after sheath withdrawal are required.     

Local vascular complications after heart catheterization

BACKGROUND: A prospective study was carried out to clarify the efficacy of an endoscopic screening program for detecting superficial colorectal neoplasias by color changes such as faint redness or discoloration, which have been described as a key finding of these lesions in the literature. METHODS: We enrolled 716 consecutive cases in this study, but more than half of them did not reveal any abnormalities colonoscopically. RESULTS: Of the 716 cases, 48 (7%) were examined by magnifying colonoscopy with a dye spraying technique, following the detection of superficial color changes. Sixteen neoplastic lesions (in 16 cases) were detected among the 48 cases and the detection rate was calculated as 2.2% (16/716) in the total number of cases and 33% (16/48) in those showing color abnormalities. Histologically, all of the 16 were adenomas. These neoplastic lesions were most frequent (52%; 11/21) in those showing faint redness in an oval shape, whereas 14 (94%) of the 15 lesions were non-specific in those showing faint redness with unclear margin. CONCLUSIONS: These results may confirm the diagnostic utility of color abnormality, particularly faint redness in an oval shape, for endoscopic screening of superficial colorectal neoplasias.     

The Ultracor tilting disc heart valve prosthesis: a seven-year study

This review aims to explain why H1 histone can be considered as a protein involved in protecting genomic DNA from full methylation. Some of our results indicated that, to explain the multiple roles in which H1 histone seems to be involved, it is important to consider that it is not a unique protein but a family of genetic somatic variants and that every one of them can be dynamically modified by different post-synthetic enzymatic modifications. Our data show that H1 histone plays an inhibitory effect on DNA methylation through its H1e variant and that poly(ADP-ribosyl)ation is a post-synthetic modification involved in this regulatory role. The idea that the poly(ADP-ribosyl)ated isoform of H1e could be present in decondensed chromatin structure, where the housekeeping genes are located, will be discussed.     

The design, fabrication and evaluation of a trileaflet prosthetic heart valve

Although prosthetic heart valves have been in existence for many years, the need for new improved designs and in-vitro evaluation techniques are apparent. This paper presents details on the design considerations, fabrication techniques and heart valve evaluation equipment. A valve performance index is discussed in light of various valve and mock circulatory test section designs. The need for national and indeed international valve evaluation techniques is made apparent.     

Minimizing complications of ultrasound-assisted lipoplasty: an initial experience with no related complications

Numerous complications and increased operating times were reported with ultrasonically assisted lipoplasty in the first several months after introduction of the technology in the United States. The purpose of this study was to review early reported complications and management regimens, evaluate possible causes of problems, and apply indications and techniques to attempt to minimize complications during an initial experience with this technique beginning in January of 1997. Seven specific indications and modifications of existing techniques were developed and applied to an initial clinical series of 70 consecutive patients who underwent ultrasound-assisted suction lipoplasty between January 10, 1997, and August 1, 1997. Follow-up ranged from 1 to 7 months. No perioperative or postoperative complication occurred in any patient in this series. In this series of ultrasound-assisted lipoplasty cases, application of the following criteria resulted in a series of 70 patients with 1 to 7-month follow-up without complications: (1) selecting patients with well localized fat deposits who were no more than 20 percent above their ideal body weight; (2) infusing a solution of Ringer's Lactate containing 1 cc of 1:1000 epinephrine per 1000 cc into the area of fat removal, stopping infusion when the tissues first become firm, not infusing to marked tissue turgor or skin induration; (3) restricting the level of energy application to a minimum of 1 cm from the undersurface of the dermis; (4) limiting ultrasonic energy application in each area to approximately 1 minute per estimated 100 cc of total aspirate in a wet to superwet environment; (5) not performing ultrasound-assisted lipoplasty in the same area as another procedure that could potentially compromise tissue vascularity; (6) using a Lysonix 2000 generator and 5-mm golf tee tip probe at a power setting of 8 to apply ultrasonic energy to the area of fat removal, ceasing energy application when tissue resistance to the passage of the probe decreases and moving the cannula as rapidly as tissue resistance allows; and (7) using a standard elastic garment without adherent foam or other materials for 2 weeks postoperatively, encouraging all normal activity immediately, and restricting aerobic activities for 2 weeks.     

Lambl's excrescence as tumorous heart valve mass

HISTORY AND CLINICAL FINDINGS: A 44 year old woman consulted a general physician because of weakness and fatigue. 5 months ago otitis media and a urinary tract infection had been treated successfully with antibiotics. The physical examination was unremarkable except for healed scars after an orthopedic operation about 35 years ago and a resection of a benign tumor of the left breast about 14 years ago. INVESTIGATIONS: Except for a slightly elevated antistreptolysin titer the laboratory tests were normal. The ECG showed sinus rhythm, left axis deviation and normal ST-segments. In the transthoracic echocardiogram an echogenic mass adherent on the ventricular side of the noncoronary cusp of the aortic valve in size of 2 x 1.5 cm could be demonstrated. The mass moved with the normally functioning valve and prolapsed into the aorta ascendens. The Doppler-echocardiogram was normal. TREATMENT AND COURSE: Because of the size of this echogenic mass with unknown origin and the risk of an embolic event its removal was indicated. This was done without destroying the aortic valve. Postoperative echocardiography demonstrated normal valve function. The histologic examination showed an endothelialized mass, rich in fibers and with only a few fibroblasts and histiocytes, without smooth muscle cells, according to a Lambl's excrescence. CONCLUSION: Cardiac valve tumors are rare. The differentiation between surface excrescences on the cardiac valve and neoplasia is only possible by histologic examination. Because of its possible malignancy and the potential risk of emboli surgical treatment is indicated.