Executive management education in health care at a naval medical center: a descriptive report.

Resource constraints in a time of conflict place particular stress on military medicine, especially in view of demands for medical care due to injuries. Effective management of health care systems and resources is essential. Management education of clinical leaders therefore is an excellent investment of time and effort. This article describes a Master's of Public Health degree program customized to meet the needs of the naval health care system and facilitate active involvement of current employees.

Tonsillectomy in the anticoagulated patient.

OBJECTIVES: The objectives of this study were to review perioperative bridging strategies for anticoagulated patients and to describe a novel bridging strategy for tonsillectomy in an anticoagulated patient that addresses both primary and secondary hemorrhage risks. METHODS: A literature review and a case report are presented. PubMed was reviewed for evidence-based recommendations on perioperative management of anticoagulated patients. A case report is detailed of a 28-year-old woman with antiphospholipid syndrome on warfarin for high risk of venous thrombosis who underwent tonsillectomy. A perioperative bridging strategy incorporating outpatient low-molecular weight heparin and inpatient unfractionated heparin was implemented to minimize risks of thrombosis and primary and secondary posttonsillectomy hemorrhage. RESULTS: Limited evidence supports a consensus on the best perioperative management of anticoagulated patients. Tonsillectomy in an anticoagulated patient has not been described previously. The patient in this case underwent successful tonsillectomy with no thrombosis or bleeding after 1 month of follow-up. CONCLUSIONS: Tonsillectomy can be done relatively safely in an anticoagulated patient at high risk for thrombosis. The perioperative bridging strategy should account for its unique risk of primary and secondary postoperative hemorrhage. A proposed algorithm for managing these competing risks is presented.

The effects of autologous platelet gel on wound healing.

Laser resurfacing techniques have become a popular means of achieving rejuvenation of damaged skin. Interest is great in attempting to speed re-epithelialization and healing so that patients can return to their normal activities as quickly as possible. Previous studies have demonstrated that wounds heal more quickly when they are covered and kept moist than when they are left open to the air. Until now, no study has been conducted to investigate whether the healing process of a superficial skin burn might be accelerated by the use of an autologous platelet gel as a biologic dressing. Our study of five pigs showed that autologous platelet gel can influence wound healing by stimulating an intense inflammatory process that leads to highly significant increases in the production of extracellular matrices and granulation tissue. The platelet gel accelerated vascular ingrowth, increased fibroblastic proliferation, and accelerated collagen production. However, the gel did not appear to accelerate re-epithelialization. The aggressive production of granulation tissue and the acceleration of collagen production might mean that autologous platelet gel will have a future role in the treatment of burns because the highly vascularized bed it helps create should promote the success of skin grafting in patients with deep partial-thickness and full-thickness burns.

The percutaneous columellar strut.

BACKGROUND: Understanding tip support mechanisms is essential for nasal surgery, especially for preservation or augmentation of tip projection. METHODS: Support of the nasal tip often is improved by the use of struts placed between the medial crura. The percutaneous columellar strut is a technique that provides additional tip support during septoplasty and closed rhinoplasty. The strut is placed via a small vertical columellar incision. RESULTS: The advantage of easy and simple insertion outweighs the minor potential disadvantage of a small, visible vertical columellar scar. It is useful in addressing tip ptosis when trauma, surgery, or aging has reduced the contribution of the septum to tip support. CONCLUSION: A detailed description of the percutaneous columellar strut technique and results of its application are presented.

Gene therapy, electroporation, and the future of wound-healing therapies.

Chronic wounds are a major clinical problem with notable morbidity. Treatment is usually supportive and results in significant healthcare expenditures. It is estimated that 1.25 million people are burned each year in the United States and that 6.5 million have chronic skin ulcers caused by pressure, venous stasis, or diabetes mellitus. Wound healing is a complex and lengthy process, often taking up to 12 months to complete. The cost of treating poorly healing foot wounds in the United States has been estimated at $1 billion per year. A number of topical commercial products have become available to provide an optimal environment for problematic open wounds. Topical platelet-derived growth factor (PDGF)-BB has proven effective in improving healing in impaired wounds but has the disadvantage of requiring large and repeated doses. More recently, investigators have focused on the possibility of inserting genes encoding for growth factors such as PDGF-BB into the cells participating in the wound-healing response. This approach offers the potential of single-dose growth factor treatment of chronic wounds. There are several approaches for gene insertion, including viral vectors, gene guns, and electroporation. This article reviews the strategies and potential of these approaches, with a focus on electroporation.