Statistical analysis and study design in plastic and reconstructive surgical research.

Appropriate study design and proper statistical analysis are necessary ingredients for improving the quality and reliability of the information in journal articles. General surgery and plastic surgery articles were compared for principal author's academic degree, a Ph.D.'s presence as a coauthor, the study type, the presence of statistical analysis, the analysis' appropriateness, and the types of errors in study design or statistical analysis. Ph. D. authorship was associated with increased percentage of articles using statistical analysis. When compared with general surgery articles, plastic surgery articles performed four times fewer statistical analyses. However, when statistical analyses were performed, there were few differences between these two specialties. Although there were no differences in the types of statistical analysis errors, there were differences in the types of study design errors. The causes of these discrepancies may lie in the nature of plastic surgery; they may be reduced by adherence to Feinstein's principles of study design and result interpretation.

The use of prophylactic antibacterials in plastic surgery: a 1980s update.

A questionnaire designed to determine the pattern of usage of prophylactic antibacterials, similar to one used a decade ago, was distributed to plastic surgeons, of whom 1718 responded. The pattern of antibacterial use in 8 major categories and 55 separate operations and circumstances was reviewed. The timing and the influence of various modifying factors was evaluated. The data present the pattern of antibacterial use by plastic surgeons at this point and time, that is, what is "usual and customary".

Tracheostomy-related subglottic stenosis: bacteriologic pathogenesis.

Subglottic stenosis carries devastating consequences. Its pathogenesis, and therefore prevention, have thus far eluded precise definition. The following data suggest that tracheostomy results in a contaminated wound, secondarily infecting a larynx which may have been injured by prior intubation, fracture, or surgery. The interpretation of these data is based upon the tested assumption that infection prolongs healing of injured tissue and predisposes to scar and stricture formation. Therefore, the ability of control stomal contamination by the judicious use of topical or systemic antibiotics may play an important role in the prevention of complications in an organ functionally by-passed by the tracheostomy cannula.

Chronic bacterial tonsillitis: fact or fiction.

Chronic bacterial tonsillitis can be validly supported etiologically by quantitative bacteriologic methods. The following observations are based on a recognition that the mere presence of bacteria is much less significant than the level of bacteria present. The chronically infected adult patient may be characterized by tonsils subclinically harboring greater than 10(5) bacteria/gm as opposed to the control patient with 10(3) bacteria/gm. Useful features in predicting high bacterial levels are (1) low number of crypts, (2) presence of nodal hypertrophy, and (3) tonsils small by actual size. Estimated tonsil size, determined preoperatively, shows no statistically significant correlation with either actual size or degree of tonsil sepsis.

Denervation supersensitivity and the delay phenomenon.

We have reviewed the denervation supersensitivity-AV shunt hypothesis (explaining the delay phenomenon) and assessed the contribution of each of the two components of denervation supersensitivy to delay. We concluded that adrenergic denervation supersensitivity contributes little to the delay phenomenon. We propose a new hypothesis, based on the effects of prolonged vascular smooth muscle relaxation in the precapillary arterioles, to explain the delay phenomenon.

Double-blind comparison of iodamide and diatrizoate for excretory urography.

A double-blind comparison of meglumine iodamide and Renografin 60 (52% meglumine diatrizoate and 8% sodium diatrizoate) for bolus excretory urography was performed. Doses of 0.8 cc/kg. to a maximum of 55 cc were administered to fifty patients, twenty-five receiving each drug.There is a suggestion that iodamide may be superior to diatrizoate in pyelocalyceal opacification while being equal to diatrizoate in parenchymal opacification and in types and severity of side-effects.

Modifications in the treatment of the multiple injury patient.

When burns complicate the management of an otherwise severely injured patient, modifications in treatment must be undertaken for both problems. The unique situation of this type of patient often requires the use of multiple therapeutic interventions which may differ from the usual. The use of controlled hypotension and aggressive surgical burn management was successful in allowing the postponement of vascular surgery in a young male patient with a traumatic aortic disruption and extensive burns resulting from a 60-foot fall and severe thermal burns.

Psychiatric complications in a surgical ICU.

Pathological behavior patterns are often observed in patients in the ICU. In a Surgical ICU (SICU), 7% (22/322) of a patient population required psychiatric consultation during a 6-month period. As a group, these patients had more prolonged stays, more frequent requirements for mechanical ventilation, a higher incidence of cardiac arrest and a higher mortality rate than the entire SICU population. The psychiatrist was asked to evaluate multiple behavioral syndromes, some of which were irreversible concomitants of grave illnesses. However, with certain syndromes, psychiatric assistance greatly facilitated the resolution of problems that hampered pre- and postoperative management and the patient's eventual recovery.

Objective assessment of the trauma patient in a surgical intensive care unit.

A 6-month study using the Therapeutic Intervention Scoring System (TISS) to evaluate trauma patients admitted to a surgical intensive care unit showed a correlation between severity of illness and TISS score at the same time. The TISS is useful in the ICU, where numerous complex interventions are made in caring for acutely ill and injured patients.

The undelayed Mütter flap in head and neck reconstruction.

Twenty-one mastoid-occiput-based shoulder flaps have been used to reconstruct patients with head and neck cancer. When the tip of the flap does not extend beyond the midclavicle, this flap can safely be elevated and transferred into its final position without delay procedures. Not requiring secondary sectioning and implantation, the Mütter flap can successfully be used to reconstruct multiple defects within its arch. Its utility thus rivals the more commonly used medially based deltopectoral flap and forehead flap.

Barium granuloma of the rectum: an uncommon complication of barium enema.

Barium sulfate granuloma of the rectum may develop when this contrast material is forced through a discontinuity in the rectal mucosa. The ensuing mass may be confused with carcinoma. Preoperative biopsy and attention to plain films will prevent unnecessary inappropriate surgery.

Scalping injury.

The history of scalp avulsions is presented, and one case is reported. A treatment plan for scalped patients is outlined.