The history of computing.

This article follows the development of computerized devices from the primitive manual systems of the ancient world to the sophisticated electronic devices of today.

Computed tomography--its principles and application to the diagnosis of facial fractures.

The introduction of microcomputers with their chips of integrated circuits and ability to rapidly perform thousands of complex mathematical instructions has enabled the clinician to readily use and manipulate tomographically acquired data from relatively narrow body slices. These data allow identification of complex injuries and disease states through the construction of detailed anatomic images and the differentiation of structures of low densities and those of subtle density differences.

Computer use in the medical specialties.

This article summarizes new and innovative uses of the computer in various medical applications. It highlights the use of this technology in the fields of Cardiology, Radiology, Rehabilitative Medicine, Laboratory Medicine, and so on. It also discusses future uses in aiding the handicapped patient to ambulate, the deaf to hear, and the blind to see.

Video conferencing and real-time communication.

We believe that network national and international teleconferencing is viable and that the problems remaining have mostly to do with overcoming reluctance to change, reorganizing one's thinking, and making the equipment easier to use--essentially minimizing behavioral and operational constraints. Those of us who use audiographic teleconferencing are enthusiastic. In an era of increasingly rapid change and energy consciousness, teleconferencing should be considered. Finally, we experienced how national and international teleconferencing can meet various medical requirements, while at the same time achieving decentralization of human resources. We also considered the impact of teleconferencing on the daily business of people, as well as the social, medical, and economic activity relative to teleconferencing systems on a large scale. If the mastery of information technology is a challenge of the Eighties, then it appears that national and international teleconferencing as an integral feature of any professional environment--medicine, dentistry, engineering, education, and so on could be very supportive in cultivating a national and international exchange of ideas. The end result of teleconferencing is the benefit realized from improved group communication and the efficient use of time, both professional and personal.

Image processing--principles and its future applications in reconstructive and aesthetic plastic surgery.

Although the great importance of the visual aspect to medical science, and plastic surgery in particular, is beyond doubt, the utilization of image systems for transmission, storage, and processing of images is not at all widespread. The main reason for this phenomenon is that owing to the high complexity of imaging-related equipment, in comparison with other means such as audio equipment (telephone, tape recorders, and so on), more complicated systems are required, including wider broadcasting channels, much larger storage capacities, and higher processing speeds than are available now. Except for extensive research and development activities in the universities, research institutes, and military organizations, the large potential of the artificial visual aspect is not commonly utilized. In the future, efficient utilization of image processing capabilities in the service of plastic surgery will be achieved by the emerging capabilities for many complicated procedures. These include huge image data base processing, automatic detection of pathologic cases by enhancement of details and recognition of patterns, accurate measurements of the changes and distortions in the processed images, prediction of results to allow planning of treatment, simulation, and training on computerized cases. The new capabilities also include visual control of robotic arms for complicated operations, better audio-visual communication between faraway clinics and medical centers via sophisticated teleconferencing systems--which will save traveling expenses and time and will enable the updating of medical information--and many more applications that will be developed when the basic equipment becomes an integrated part of the clinics and plastic surgery departments. Future image processing will enhance the visual aspect in the plastic surgeon's work and will enable the doctor to expand his or her professional capabilities.

Data storage and retrieval.

The entire face of modern medical and surgical practice is being significantly affected by the application of technologic developments to the practice of surgery--developments that will tie together such areas as information management and processing, robotics, communication networks, and computerized surgical equipment. The achievements in these areas will create a sophisticated, fully automatic system that will assist the plastic surgeon in many aspects of work, such as regular office activities, doctor-patient interaction, professional updating, communication, and even assistance during the operational process itself. It will be as simple as dialing a telephone today. When it is necessary to consult with other colleagues, a combined vocal and visual consulting network in other medical centers as well as consulting computerized expert systems will be available all day and night as part of the communication services. The plastic surgical expert systems will store valuable information, based on the knowledge of the best human experts, on any important subtopics and will be accessed in a very friendly way. This will be an invaluable tool for the residents in training, for emergency room work, and for just getting a second opinion, even for the more experienced practitioner. All the electronic mail, professional magazines, and any other required professional information will flow between central and personal retrieval systems. The doctor, at a desired time in the privacy and comfort of his or her own home or office, can read the mail, make required changes to suit his or her needs, and store, send back, or distribute information, all in a speedy and efficient manner. The simulation of a planned surgery will give the surgeon the ability to prepare and will prevent difficulties during complicated procedures through the luxury of a dry run, without any sequelae if certain expected outcomes fail to materialize. The preprogrammed control of sophisticated surgical equipment and the use of robotics would generate new operational possibilities for more complicated surgeries, which are now prevented owing to the surgeon's physical limitations. Information urgently required during the operation as a result of an unexpected situation will be available immediately from storage and retrieval systems, and real-time vocal and visual consulting with expert colleagues, often in remote locations, will bring the operations process itself to a new era.(ABSTRACT TRUNCATED AT 400 WORDS)

Basic principles of computer technology.

This article explains the functions of the different components of computer systems and how they work together. Covered are computer central processors, various peripheral accessories, and the types of software that control them.

Computers and medical office management.

This article outlines the possible uses of computers and software in the management of a medical office. It highlights many issues that should be considered in choosing a system.

Complications of breast reconstruction.

The authors discuss general complications of breast reconstruction, complications associated with reconstruction with subcutaneous or submuscular prostheses, complications of latissimus dorsi musculocutaneous flaps, and complications of transverse abdominal island flaps. Although no surgeon can expect to perform a series of complex yet delicate operations such as breast reconstructions and escape the complications described, it is hoped that by utilizing sound judgment in patient and procedure selection and having detailed knowledge of the procedure to be performed, such complications can be kept to a minimum and managed to a satisfactory resolution if and when they do occur.

Reconstruction of the hand with free microneurovascular toe-to-hand transfer: experience with 54 toe transfers.

Over a period of 6 years, 54 toe-to-hand transfers were performed, 24 for thumb and 30 for finger reconstruction. Refinements in evaluation, preparation, and surgical technique are detailed. Forty-nine toes (90.7 percent) survived. Exploration was required for circulatory compromise following 13 transfers (34.2 percent), to good effect in 9 (69.2 percent). Secondary surgery was performed in 26 cases, consisting of tendolysis, osteotomy, and deepening of the first web space. Review was undertaken at an average of 1 year and 9 months after transfer. Power grip averaged 28.5 percent of the normal hand and pinch strength 26.6 percent, great toe transfer giving 35.7 percent and second toe transfer to thumb giving 15.6 percent strength compared with normal. Static two-point discrimination of less than 10 mm was present in 37.5 percent of those studied under 2 years after surgery and in 75 percent of those studied more than 2 years later. The choice of procedure for thumb reconstruction is discussed in detail, as are supplementary skin cover, vascular considerations, and the high exploration rate.

Adjustable dynamic external splint for control of first web contracture.

A method is presented to overcome problems of first web space contracture by means of a dynamic, continuously adjustable, wedge-shaped splint. The device is easily constructed of inexpensive material by physician or hand therapist. The splint is custom-tailored to the individual patient and is lightweight and comfortable, promoting good patient compliance. Its continuously adjustable nature maximizes its effects throughout therapy, and the even distribution of the pressure makes for a high surface area of patient/splint contact for even pressure distribution and eliminates the problems of skin necrosis, even with lengthy applications.

The "antenna" procedure for the "hook-nail" deformity.

The hook-nail deformity is a relatively common problem after fingertip amputations. It is usually ignored but can be quite disabling. This deformity can be corrected by a carefully planned operation. Most of the curved nail plate is removed, the pulp is reflected from the distal phalanx out to a normal contour, and then the full thickness of the nail bed is elevated off the distal phalanx and splinted by multiple small Kirschner pins in a straight position. The defect created is covered with a cross finger flap.

Infiltrating lipoma of the proper digital nerves.

Lipomas are one of the most commonly encountered benign soft tissue tumors. Their frequent occurrence and exact anatomic distribution in the hand and upper extremity have been well documented. A review of the current literature shows that these lesions are most often asymptomatic and occur only rarely with the fingers. Our recent experience has been at variance with this is that we have encountered two patients with symptomatic infiltrating lipomas of the proper digital nerves. The following report documents the clinical presentation, treatment, and postoperative course of these patients.

Dorsal skin and fingernails on the volar aspect of the hand: an unusual anatomic deformity.

A very unusual hand malformation is reported in which dorsal skin and nails exist on the volar aspect of the hands. This patient also exhibits mental retardation and microcephaly as well as a partial deletion of chromosome 6. Fifty percent of a small series of patients previously reviewed who presented with chromosome 6 abnormalities demonstrated abnormalities of the hands. Unusual deformities of the hands associated with mental retardation and microcephaly may be related to an abnormality of chromosome 6.

Results of surgical treatment of painful neuromas of the hand.

The surgical treatment of 50 patients with 101 neuromas over the last 10 years is reported. Simple excision and implantation into local muscle resulted in an unacceptable reoperative rate of 65%. Ray amputation for symptomatic neuromas resulted in the highest reoperation rate but resulted in little or no subjective improvement. There appears to be a correlation between delayed healing after the initial injury and the severity of neuroma symptoms. Dorsal translocation of the neuroma consistently resulted in decreased sensitivity without longterm recurrence.