Skin fluorescence,a method to predict amputation site healing

Although skin blood flow is an important determinant of amputation site healing, most techniques to evaluate it are cumbersome and indirect. We have prospectively compared a new, simple and direct technique, skin fluorescence (SF), with a more established indirect method, segmental limb blood pressures (BP), to determine the value of each in predicting amputation healing of an ischemic extremity. Twenty-six consecutive patients with ischemic tissue loss were studied prior to amputation. Thigh, calf, and ankle BP were measured; then SF was determined by injecting 10–15 mg/kg of fluorescein intravenously and examining the limb with uv light. BP of > 50 mm Hg was considered adequate for amputation wound healing; yellow SF indicated adequate skin blood flow. In each case, the most distal site predicted to heal by either method was selected for amputation. Thirty amputations were performed (6 digital, 3 transmetatarsal, 11 below knee, and 10 above knee) with an 80% healing rate. When SF and BP disagreed on the level of amputation, fluorescein always predicted a more distal site. SF accurately predicted amputation healing in 80% of cases. In the remaining 20%, amputation failures were due to infection in two and deep tissue necrosis in four. BP was accurate and useful in 47% of cases. In 14 patients BP indicated the need for a higher level of amputation than was successfully performed. In two patients BP measurement was indeterminate due to “stiff arteries.” Furthermore, in two patients amputations failed despite BP > 50 mm Hg. We conclude that SF helps the surgeon select a more distal level of amputation than segmental limb pressures, and one that has a high likelihood of healing.     

Acute traumatic rupture of the aorta. A re-emphasis of repair without a vascular prosthesis

The incidence of acute aortic rupture has paralleled the increasing number of high-speed vehicles on our highways. Repair of acute aortic rupture without a vascular prosthesis has been mentioned frequently but seldom applied. Three consecutive patients with acute rupture repaired without a vascular prosthesis are discussed. The advantages of this technique are reviewed, and technical factors of the operation are described.     

Efficacy of cervical cytologic screening in the control of cervical cancer

Cervical cancer mortality in the U.S. has been declining, and this has been attributed to cervical cytologic screening. This report reviews data on the incidence and mortality of cervical cancer in order to evaluate the effect of cytologic screening. U.S. cervical cancer mortality has been declining consistently since 1946, with little change in the mortality trend after widespread cytologic screening. Incidence of invasive cervical cancer in specific geographic areas has also declined. However, the rate of diagnosis of carcinoma in situ has increased sharply and parallels increasing cytologic screening rates. A causal association of cytologic screening with the decreasing mortality and incidence of invasive cervical cancer cannot be established using current data, especially considering declining mortality prior to widespread screening and increasing removal of women from the population at risk by hysterectomy.     

The effects of reduced time limits on prolonged eating behavior

The present research investigated the effects of gradually reduced temporal limits on a child's prolonged eating behavior. A changing-criterion single-case design in both the home and other settings was used to assess the effects of the sequential series of reductions in the time limits allowed for reinforced meal completion. The instituted time limits produced reductions in the amount of time the child used to finish meals.     

The depression of T lymphocytes after trauma.

The T lymphocyte count is usually depressed during the first 24 to 48 hours after trauma or operation. It usually starts to return to normal levels by the fifth day after injury. The degree of depression is related to the severity of the injury. Acute infection appears to trigger this depression prior to operative treatment. This transient depression may be a normal physiologic event associated with the stress of trauma or infection.