摘要:

Whole blood silicon levels in 30 patients with silicone-gel implants (inserted between 1973 and 1991) were compared with those of 24 healthy, age-matched, female patients without breast implants using atomic absorption spectrometry with a graphite furnace. The blood silicon levels in the implant patients were significantly higher than those of controls (medians 33.45 vs 17.05 ng/ml; p=0.005). Of the 30 patients with implants, 15 had received their implants between 1973 and 1985, and 15 had received implants between 1986 and 1991. Implants made between 1973 and 1985 have been shown to be weaker and to have higher silicone “bleed” levels than those made from 1986 onward. However, there were no significant differences in the blood silicon levels between these two groups of patients.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In principle, tomographic imaging of breast implants provides the information needed to compute implant volume. We have investigated the reliability of this measurement as a means of diagnosing the loss of gel from the implant. We find that measurement errors, postimplantation changes of the implant, uncertainties in the patients' records, and lack of knowledge of the implant temperature in the body can lead to significant discrepancies, making this measurement unreliable as a diagnostic tool.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We prospectively evaluated 8 1 patients (with 160 implants) who subsequently had implants removed to determine sensitivity and specificity of both magnetic resonance imaging and ultrasonography. Positive and negative predictive values were also calculated to determine whether a statistically beneficial interaction existed when ultrasonography and magnetic resonance imaging were used in combination to examine an implant. Finally, the misdiagnoses were retrospectively evaluated to identify the pitfalls of the investigations. Positive diagnostic criteria were described. The sensitivity and specificity of ultrasonography were 47% and 83%, respectively, and of MRI, 46% and 88%, respectively. On retrospective review by the radiologist, the sensitivity and specificity of ultrasonography were 7 0% and 90%, respectively, and of magnetic resonance imaging, 75.6% and 94%, respectively. Although definite conclusions could not be obtained, there did not seem to be an additive benefit from using both ultrasonography and magnetic resonance imaging.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Disciplines using human body surface dimensions require accurate, repeatable measurements. This study presents a design for the analysis of repeatability, precision, and validation of a new anthropometric device. This model enables estimation of the proportion of the total variation attributable to each level of data collection. This model is applied to an analysis of repeatability, precision, and validation of the Cencit Imaging System, a new optical surface scanner. Twenty-seven facial landmarks were marked on 10 men and 10 women at two measurement sessions. Two images were scanned during each session, and each image was digitized twice. The Cencit Imaging System results were compared with a previously validated digitizer. The Cencit Imaging System was found to produce accurate, highly repeatable images. Much of the error in this study is attributable to human error in marking landmarks on the subjects. The new imaging system will prove useful in a variety of anthropometric applications.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We report the long-term social and functional results in 53 patients receiving free tissue transfer after trauma to the lower extremity. The results are compared with those of a matched group of patients receiving primary amputation. The microsurgically treated patients had significantly more complaints over pain during walk (p=0.02) and edema (p<0.00005). Regarding social results, no significant differences between the two groups were found. Time until surgery, infection, or bone defect before free flap surgery did not alter the overall results significantly. It is concluded that the long-term functional and social results after free tissue transfer are almost the same as those achieved after simple amputation. Because the median time until free flap surgery in this series was 158 days, early limb-saving procedures could possibly improve the long-term results.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Over the years, although methods of breast reconstruction have improved, the ability to build a symmetrical projecting breast has not. When stacked Meme implants were used, better projection was obtained. Folding the transverse rectus abdominis musculocutaneous flaps allows for good projection; however, the breast is then quite wide and large. For smaller breasted women with projection and some larger breasted women as well, splitting and stacked flaps give a much better result. We now do this procedure with simultaneous Latram and mastectomy surgery in fewer than 3 hours.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Tissue expansion for correction of male pattern baldness has not gained wide acceptance by patients or surgeons because of the substantial albeit temporary deformity of the expansion. Minimal expansion is an alternative. Scalp flaps can be expanded just to the point of becoming noticeable over 4 to 6 weeks followed by scalp flap transposition and easy closure of the donor site. The temporoparietal (Juri) or superiorly based (Dardour) flaps have been used unilaterally or bilaterally. The entire restoration is completed in approximately 8 weeks, is minimally deforming during the expansion phase, and does not require the patient to alter his lifestyle significantly or to go into hiding. Hair grafts, in contrast, do not begin to grow hair until 12 weeks after transplantation, and the process usually requires four sessions over an 8-to 12-month period with the patient looking temporarily variably absurd. Tissue expansion increases scalp available for flap restorations, which appear more natural than even the most well-executed hair transplants. Minimal expansion makes the process more palatable to the patient and surgeon.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Standard technique for hair transplantation includes plug composite grafts placed in circular recipient defects of smaller diameter. The plugs can also be placed in slit incisions that are temporarily dilated to accommodate grafts. Two drawbacks of these techniques are the appearance of row cropping resulting from the regular pattern and compression of individual grafts caused by scar contracture. These drawbacks result in tufting and a “doll's head” appearance. The expansile Mercedes incision as described here camouflages these failings. Donor minigrafts are taken with a biopsy punch knife or as strips in a standard fashion. A Mercedes logo—shaped defect is then made at the recipient site using a no. 11 scalpel to create a three-armed stellate incision. The incisions are rapidly made with the axis oriented parallel to the direction of the native hair shafts. The graft is then pushed in flush with the skin. The triangulation eliminates compression of grafts because they are spread in three directions rather than squeezing in a tight circular or slit configuration. The use of the stellate incision along with altering its rotational orientation in a haphazard pattern also prevents row cropping. Thus, the Mercedes incision is quicker and yields an overall improved result.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Nerve compression causes injury by local ischemia and direct mechanical distortion. Peripheral nerves in diabetes mellitus are more prone to injury than those of nondiabetics. We sought to determine whether reperfusion-induced, oxygen-derived free radical injury occurs in peripheral nerves subjected to acute compression in normal and chronically diabetic rats. Female Sprague- Dawley rats weighing 250 to 275 g (N=347) were divided into two groups: normal and streptozocin-induced diabetics. A total of 187 normal and 160 diabetic nerves were analyzed. After 8 weeks of untreated hyperglycemia, the sciatic nerves of normal and diabetes mellitus rats were subjected to one of three operations: a sham operation, 24-hour compression alone, and 24-hour compression followed by 1-hour reperfusion (CR). Nerve compression was established by banding the right sciatic nerve with a Silastic tubing, 1 cm long and 0.62 mm internal diameter, which was secured with 6-0 nylon suture. In the CR group, after 24 hours of compression, the tubings were released for 1 hour to permit reperfusion. Nerve tissue within the zone of compression underwent biopsy examination and was frozen for subsequent analysis. Blood flow to the nerve was quantified by injecting fluorescein (10 mg/kg intravenously) 10 minutes before harvest and measuring tissue levels fluorometrically. Compression with the Silastic tubing significantly reduced neural blood flow by 75%. Blood flow improved but failed to return to baseline levels after tubing release in diabetes mellitus nerves while perfusion returned to baseline in non-diabetes mellitus nerves. Nerve homogenate was assayed for malonyldialdehyde, an indicator of lipoperoxidation, as well as enzymes of cellular defense and glucose metabolism. Antioxidants, deferoxamine and lazaroid U74389F, were given at various time intervals in an attempt to reduce oxidative injury. Malonyldialdehyde levels rose significantly after reperfusion: a 310% increase from baseline in diabetes mellitus nerves (p<0.01) and a 147% increase in non-diabetes mellitus nerves (p<0.05). Enzymes of cellular defense and glucose metabolism increased activity during nerve compression (ischemia). While activities remained elevated or increased in non-diabetes mellitus nerves after reperfusion, enzyme activities in diabetes mellitus nerves tended to decline, suggesting an inability of diabetes mellitus nerves to tolerate reperfusion-induced metabolic stress. Both deferoxamine and lazaroid U74389F significantly reduced malonyldialdehyde levels from those of untreated controls in reperfused diabetes mellitus nerves. We conclude that incomplete ischemia was created in this experimental model and peripheral nerves were susceptible to free radical damage as reflected by increased lipid peroxidation and decreased antioxidant defenses. Diabetic nerves were more susceptible to free radical damage than non-diabetes mellitus nerves.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We retrospectively reviewed 26 cases of primary or recurrent cutaneous foot malignancies for which patients underwent tumor extirpation and reconstructive surgery between 1990 and 1994. The most common disease was malignant melanoma (24 cases), and most tumors were located on the heel and midplantar area. Free tissue transfer was used for nine reconstructions, and various types of plantar, rotation flaps, or split-thickness skin grafts were also used. Twenty-five patients were ambulatory postoperatively without the use of corrective shoes or supportive devices. Sensation was noted to be normal in 20 patients, decreased in 4, and increased in 1. Two free tissue transfers were lost in the same patient because of venous thrombosis. Other complications included partial flap loss, skin graft loss, and flap dehiscence. Several patients have resumed pretreatment running regimens. Cutaneous tumor extirpation followed by reconstructive surgery of the foot does not inhibit the cancer patient's ability to function normally.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID