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Directional variations in the extensibility of human skin
ABSTRACTS GENERAL CONSIDERATIONS Total Parenteral Nutrition Using Peripheral Veins in Surgical Neonates. K. lkeda and S. Suita. Arch Surg 112:1045 1049
(September), 1977 Thirty-four neonatal surgical patients with life-threatening gastrointestinal problems were treated with total parenteral nutrition (TPN). The T P N is based on the use of fat emulsion as the major source of calories and the infusion of large volumes via peripheral veins. Amino acids were given from 1.0 to 3.0 g m / k g / d a y and the lipid was administered as a 10% emulsion of soybean oil. Fat emulsion is not used in patients with biliary atresia or neonatal hepatitis. When SGOT and SGPT reach levels over 100 units, therapy is discontinued until these enzymes fall below this limit. Carbohydrates such as glucose and fructose were also used and trace elements were added where infusions were prolonged for more than 3 wk. Details of composition and accruement are given.--EdwardJ. Berman Continual Catheter Administration of an Elemental Diet in Infants and Children, R. J. Andrassy, CP. Page, R.W.
Feldtman, R.C. Haft, J.A. Ryan Jr., and I.A. Rather. Surgery 82:205 210 (August), 1977. The use of continual tube feeding of an elemental diet for alimentation in 150 infants and children is described. The authors emphasize the importance of continuous infusion with an initially low concentration and rate of delivery, which are gradually increased to the desired levels. Clinical and laboratory monitoring is essential. Complications have included poor tube placement, fluid overloading, and transient hypernatremic dehydration. The authors indicate that metabolic complications similar to those occurring with parenteral hyperalimentation are possible because of the similar composition of the administered fluid, but the severity and frequency are much less.--William K. Sieber Steroids and Severe Hemorrhagic Shock. J. Pinilta and C. J.
Wright. Surgery 82:489-494 (October), 1977. This study involving the monitoring of hemodynamic (mean arterial pressure, cardiac index, total peripheral resistance, femoral artery blood flow, and capillary muscle blood flow) and metabolic (oxygen uptake and lactate production) parameters in 30 dogs did not demonstrate any advantage of steroid therapy in the management of severe hemorrhagic shock in this model--William K. Sieber Serial Changes in Arterial Structure Following Radiation Therapy. E. W. Fonkalsrud, M. Sanchez, R. Zerubavel, and
A. Mahoney. Surg Gynecol Obstet 145:395 400 (September), 1977. Acute and chronic morphologic changes in the endothelium and media of femoral arteries in 12 adult mongrel dogs following 4000 roentgen units given over a 10-day period were evaluated by light and scanning electron microscopy. The endothelium showed evidence of moderate to severe acute injury within 48 hr. Repopulation of the luminal surface with new cells became apparent within 3 wk but was still incomplete at 4 mo. The internal elastic membrane appeared to be preserved following radiation. The media showed minimal alteration during the first week after which
199 a progressive increase in cellularity and later fibrosis with focal areas of necrosis occurred. The adventitia showed progressive hemorrhage and chronic inflammation. The results of this study suggest that the morphologic alterations in the media and adventitia may be long-lasting and perhaps permanent in contrast to the more acute changes with gradual repair in the endothelium.--George Holcomb
ANESTHESIA AND INHALATION THERAPY Neuroleptoanalgesia in Pediatric Anesthesiology. F. Lhpez, M. C. Gasc6, andJ. Martinez. Rev Ann Esp. Pediatr 10:57, 1977.
An anesthetic technique based on the use of a neuroleptic agent (Droperidol) and an analgesic (Fentanest) applied to pediatric surgery is presented. This method has been used in a series of 33 infants undergoing various surgical procedures. Doses given, results obtained, and possible complications are discussed. This anesthetic technique is considered of election in high risk surgical pediatric patients.--C. M. Almoyna
INTEGUMENT AND CONNECTIVE TISSUE Directional Variations in the Extensibility of Human Skin. H.
L. Stark. Br J Plast Surg 30:105-114 (April), 1977. The extensibility of human skin, which enables the body to move, allows the primary closure of skin defects by advancement or by rotation advancement flaps. When an extending load is applied to human skin in vivo or in vitro the skin stretches with very little increase in load until a limit is reached (limit strain) after which much greater increases in load are required to extend it further (terminal stiffness). At many sites there are marked directional variations, the direction of maximum limit strain being the same as that of minimum terminal stiffness and vice versa, Langer's cleavage lines correlate very closely with the direction of minimum limit strain and maximum terminal stiffness (i.e., least extensibility). Varying patterns of extensibility depend on the joint movements also. For instance, in the lower leg where there is no movement of the skin there is little extensibility.--A. Jolleys A Syndrome of Congenital Lymphedema of the Upper Extremity and Associated Systemic Lymphatic Malformations.
Eric W. Fonkalsrud. Surg Gynecol Obstet 145:228 234 (August), 1977. P r i m a r y l y m p h e d e m a is caused by an idiopathic maldevelopment of the subcutaneous lymphatic channels of the extremities. The experience from two girls and two boys with congenital lymphedema of one or both upper extremities and the external genitalia is reported. In each, the swelling extended from the fingers up to the shoulder, The two patients with unilateral involvement of the arm had more severe lymphedema than those with bilateral swelling. Children with severe congenital lymphedema of the upper extremities may obtain considerable improvement in function and cosmetic appearance after subcutaneous lymphangiectomy. The optimal age for the operation has not been established, although 2 yr seems preferable. Intestinal lymphangiectasia with protein-losing enteropathy occurred in two patients and was successfully managed by replacing
(September), 1977 Thirty-four neonatal surgical patients with life-threatening gastrointestinal problems were treated with total parenteral nutrition (TPN). The T P N is based on the use of fat emulsion as the major source of calories and the infusion of large volumes via peripheral veins. Amino acids were given from 1.0 to 3.0 g m / k g / d a y and the lipid was administered as a 10% emulsion of soybean oil. Fat emulsion is not used in patients with biliary atresia or neonatal hepatitis. When SGOT and SGPT reach levels over 100 units, therapy is discontinued until these enzymes fall below this limit. Carbohydrates such as glucose and fructose were also used and trace elements were added where infusions were prolonged for more than 3 wk. Details of composition and accruement are given.--EdwardJ. Berman Continual Catheter Administration of an Elemental Diet in Infants and Children, R. J. Andrassy, CP. Page, R.W.
Feldtman, R.C. Haft, J.A. Ryan Jr., and I.A. Rather. Surgery 82:205 210 (August), 1977. The use of continual tube feeding of an elemental diet for alimentation in 150 infants and children is described. The authors emphasize the importance of continuous infusion with an initially low concentration and rate of delivery, which are gradually increased to the desired levels. Clinical and laboratory monitoring is essential. Complications have included poor tube placement, fluid overloading, and transient hypernatremic dehydration. The authors indicate that metabolic complications similar to those occurring with parenteral hyperalimentation are possible because of the similar composition of the administered fluid, but the severity and frequency are much less.--William K. Sieber Steroids and Severe Hemorrhagic Shock. J. Pinilta and C. J.
Wright. Surgery 82:489-494 (October), 1977. This study involving the monitoring of hemodynamic (mean arterial pressure, cardiac index, total peripheral resistance, femoral artery blood flow, and capillary muscle blood flow) and metabolic (oxygen uptake and lactate production) parameters in 30 dogs did not demonstrate any advantage of steroid therapy in the management of severe hemorrhagic shock in this model--William K. Sieber Serial Changes in Arterial Structure Following Radiation Therapy. E. W. Fonkalsrud, M. Sanchez, R. Zerubavel, and
A. Mahoney. Surg Gynecol Obstet 145:395 400 (September), 1977. Acute and chronic morphologic changes in the endothelium and media of femoral arteries in 12 adult mongrel dogs following 4000 roentgen units given over a 10-day period were evaluated by light and scanning electron microscopy. The endothelium showed evidence of moderate to severe acute injury within 48 hr. Repopulation of the luminal surface with new cells became apparent within 3 wk but was still incomplete at 4 mo. The internal elastic membrane appeared to be preserved following radiation. The media showed minimal alteration during the first week after which
199 a progressive increase in cellularity and later fibrosis with focal areas of necrosis occurred. The adventitia showed progressive hemorrhage and chronic inflammation. The results of this study suggest that the morphologic alterations in the media and adventitia may be long-lasting and perhaps permanent in contrast to the more acute changes with gradual repair in the endothelium.--George Holcomb
ANESTHESIA AND INHALATION THERAPY Neuroleptoanalgesia in Pediatric Anesthesiology. F. Lhpez, M. C. Gasc6, andJ. Martinez. Rev Ann Esp. Pediatr 10:57, 1977.
An anesthetic technique based on the use of a neuroleptic agent (Droperidol) and an analgesic (Fentanest) applied to pediatric surgery is presented. This method has been used in a series of 33 infants undergoing various surgical procedures. Doses given, results obtained, and possible complications are discussed. This anesthetic technique is considered of election in high risk surgical pediatric patients.--C. M. Almoyna
INTEGUMENT AND CONNECTIVE TISSUE Directional Variations in the Extensibility of Human Skin. H.
L. Stark. Br J Plast Surg 30:105-114 (April), 1977. The extensibility of human skin, which enables the body to move, allows the primary closure of skin defects by advancement or by rotation advancement flaps. When an extending load is applied to human skin in vivo or in vitro the skin stretches with very little increase in load until a limit is reached (limit strain) after which much greater increases in load are required to extend it further (terminal stiffness). At many sites there are marked directional variations, the direction of maximum limit strain being the same as that of minimum terminal stiffness and vice versa, Langer's cleavage lines correlate very closely with the direction of minimum limit strain and maximum terminal stiffness (i.e., least extensibility). Varying patterns of extensibility depend on the joint movements also. For instance, in the lower leg where there is no movement of the skin there is little extensibility.--A. Jolleys A Syndrome of Congenital Lymphedema of the Upper Extremity and Associated Systemic Lymphatic Malformations.
Eric W. Fonkalsrud. Surg Gynecol Obstet 145:228 234 (August), 1977. P r i m a r y l y m p h e d e m a is caused by an idiopathic maldevelopment of the subcutaneous lymphatic channels of the extremities. The experience from two girls and two boys with congenital lymphedema of one or both upper extremities and the external genitalia is reported. In each, the swelling extended from the fingers up to the shoulder, The two patients with unilateral involvement of the arm had more severe lymphedema than those with bilateral swelling. Children with severe congenital lymphedema of the upper extremities may obtain considerable improvement in function and cosmetic appearance after subcutaneous lymphangiectomy. The optimal age for the operation has not been established, although 2 yr seems preferable. Intestinal lymphangiectasia with protein-losing enteropathy occurred in two patients and was successfully managed by replacing