ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The purpose of this project was to examine the incidence of microbial presence on the surface of mammary implants and its correlation with clinical presentation. The significance of microbial presence without signs of overt infection is questioned. Several issues are raised, including whether the presence of micro-organisms may immunize the host, trigger autoimmune reactions, or locally change the course of healing (resulting in capsular contracture). A total of 150 explanted silicone mammary implants from 87 patients were cultured. Cultures of 81 devices were positive (54%); the predominant isolate wasStaphylococcus epidermidis(found on 68 implants, or 84%). Bacteria were detected on 76% (62 of 82) of implants surrounded by contracted capsules and on 28% (19 of 68) of those without capsular contracture (p < 0.05). Among 40 patients (46%) who had no general health problems, 11 (28%) had positive cultures of explanted devices (15 of 62 explants, or 24%). In the remaining 47 patients (54%) who complained of myalgia (77%), (68%), chronic fatigue (38%), skin rashes (21%), cognitive problems (19%), dry mucosal membranes (19%), episodes of low-grade fever (17%), and hair loss (13%), 38 (81%) had positive cultures (66 of 88 explants, or 75%) (p < 0.05). The hypothesis that capsular contracture or problems that might be related to chronic infection and immunization are associated with subclinical infection is supported by this study.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In this case series, we describe the psychological and rheumatic symptoms of 52 women requesting breast implant removal. Main outcome measures include psychological evaluation with the Brief Symptom Inventory and the Beck Depression Inventory. Clinical evaluation was performed using a rheumatic symptom survey. Results noted elevation of all Brief Symptom Inventory subscales (highest in Somatization and Obsessive-Compulsive), and the Beck Depression Inventory showed mild depression. Rheumatic survey noted a mean of 12 of 23 symptoms. In conclusion, psychological distress and mild depression are noted in this group, who also may experience rheumatic symptoms of connective tissue disease. There was a moderate positive correlation between rheumatic symptoms and psychological distress.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Although a potential link between silicone-gel breast implants and autoimmune connective tissue disease has been suggested, none has been proven. The potential role of silicone as an immune adjuvant remains very controversial. Currently available techniques do not allow precise measurements of silicone in tissues. However, all compounds containing silicon (including silicone) can be measured accurately. The present study was designed to measure silicon levels in the fibrous capsules of patients with silicone-gel breast implants, saline breast implants, and silicone inflatable penile prostheses. Baseline control silicon levels were obtained from the breast tissue of patients undergoing breast reduction, who had no exposure to breast implants. All silicon measurements were carried out using atomic absorption spectrometry with a graphite furnace. Silicon was measured in a normal heptane extract of silicone from dried tissue. The mean silicon levels in 16 breast tissue control samples from 8 patients undergoing breast reduction varied from 0.025 to 0.742 μg/gm with the median mean being 0.0927. The median silicon level in capsules from six patients with saline implants was 7.7 μg/gm (range, 1.9–36.6 μg/gm). The median silicon level in capsules from five patients with silicone inflatable penile prostheses was 19.5 μg/gm (range, 1.9–34.8 μg/gm). Although the levels of silicon in capsules of patients with saline breast prostheses and penile implants were higher than in control samples, they were much lower than those from the capsules of the 58 gel implants (median, 9,979 μg/gm; range, 371–152,000 μg/gm). Of the 58 silicone-gel breast implants (from 20 patients with bilateral implant removal and 18 patients with unilateral removal) that had been inserted from 1974 to 1990, 28 were intact, 8 had pinhole leaks, and 22 were ruptured. Median capsule silicon levels and ranges for all 58 implants, for intact only, for leaking, and for ruptured were, respectively, as follows: 9,979 (371–152,000); 10,477 (371–88,703); 6,592 (3,235–65,396); and 9,922 (1,762–152,387) μg/gm. There were no significant differences in silicon levels associated with implant status, duration in situ, or year of implantation.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The descending branch of the lateral femoral circumflex artery is a large-caliber artery that passes obliquely across the upper third of the thigh and descends between the vastus lateralis and rectus femoris muscles. It sends perforators through the septum between these muscles and through the vastus lateralis muscle and supplies a large area of skin on the anterolateral aspect of the thigh. We report our experience with our first 44 consecutive anterolateral thigh flaps, which were used for a variety of softtissue deficits. Twenty-five of these flaps were used for lower extremity reconstruction, 10 were used in the upper extremity, and 9 were used in the head and neck. The overall success rate was 96%. Six flaps required reoperation; of these, 2 flaps were lost, one from a venous thrombosis and the other from arterial thrombosis, both of which were in the lower extremity. In approximately one third of cases, the flap was raised as a septofascio-cutaneous flap, but in two thirds it was necessary to include a small segment of vastus lateralis muscle as well as fascia with the flap. The flap has been particularly useful for lower extremity reconstruction, and in patients who are not fit for general anesthesia, it is possible to perform the flap transfer with epidural anesthesia. The flap has the advantage of a long vascular pedicle with large-caliber vessels and thus is suitable as a flow-through flap. It may also be sensate and has provided a versatile soft-tissue coverage option with minimal long-term donor-site complications.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The effects of tissue expansion on free flap tolerance and metabolic response to secondary ischemia were evaluated. A total of 178 male syngeneic Lewis rats were used: 28 in perfusion study and 75 donor and 75 recipient animals in flap survival study. Animals were organized in three experimental groups: control, sham operation, and expansion group. Sham group animals had the expander implanted but not insufflated. After 4 weeks of tissue expansion, 3 x 5-cm epigastric free flaps were transplanted to recipient animals. Twenty-four hours later, secondary ischemia was produced by 3-hour venous occlusion. Flap survival, perfusion, and enzyme activities were determined. Pre-expanded skin flaps had an increase in perfusion of approximately 700% as measured by fluorescein levels compared with control flaps (p < 0.001) and demonstrated a better success rate (76%) compared with those of the control (40%) (p < 0.05) and sham (28%) groups (p < 0.05). Glutathione peroxidase, glutathione reductase, and glucose 6-phosphate dehydrogenase of the anti-oxidant defense systems significantly increased in skin in both the sham and the expansion groups. In response to secondary ischemia, the control and sham groups exhibited a decrease in enzyme activities of the glutathione redox cycle, whereas the expansion group showed no significant changes from the elevated baseline activities. Tissue expansion improved flap tolerance to secondary ischemia by increasing flap circulation and probably by augmenting tissue metabolic response to oxidative stress.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The assessment of cutaneous melanoma in the clinical setting is often difficult, and important features such as depth and width remain unknown until the pathology report is received. Access to prognostic features such as vertical height before excisional biopsy would offer a basis for guidance in defining surgical margins and early planning of treatment options. Recently developed high-frequency ultrasound imaging in the 40− to 60-MHz range is a noninvasive method that provides in vivo information about cutaneous lesions. Imaging at these frequencies provides high-resolution data within the range of the epidermis and dermis (3–4 mm in depth). Ten cutaneous melanomas and seven pigmented lesions were assessed in this fashion. Vertical height was documented and compared to histopathological findings. High-frequency ultrasound imaging determination of vertical height correlated well with the standard measurement of Breslow's thickness on histological sections only in midrange (1.0–3.0 mm) lesions. Inflammatory cells at the base of three melanomas provoked an overestimation of the depth measurement with ultrasonography. Thick keratin layers such as those found on the feet acted as a virtual block to the high-frequency scanner. The application of this new advance in noninvasive imaging technology to the clinical assessment of cutaneous melanoma provides interesting in vivo data but in its present state does not replace the need for the biopsy of pigmented lesions and histopathological diagnosis.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Conventional surgical techniques used for the treatment of nasal deviations do not avoid recurrences, especially in inveterate forms. The primary alteration of the nasal osteocartilaginous framework would progressively increase and, therefore, could cause changes of structures initially not involved by the trauma, such as alar or upper lateral cartilage. According to our analysis, it is supposed that the septal perichondrium is capable of restoring its previous position. This happens especially in the inveterate forms of deviation and even when the septal straightening has already been done. The anatomopathological study points out the constant presence of the fibrous thickening of the perichondrium at the same level as the concave portion of septum, and this finding represents the anatomical expression of the scarring reaction after the traumatic event. The fibroperichon-drium is excised as radically as possible for the entire bilateral surface of the chondral septum. Good results by extramucosal perichondrectomy, associated with more conventional procedures of septum correction, in a series of 20 selected patients has encouraged reporting of the technique.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In this comparative study, we carried out liposuction on 20 patients randomly divided in two groups to find an alternative medication to epinephrine that would not result in secondary effects at the cardiovascular level but would offer a similar vasoconstricting capacity. Also, a variation of the wet technique is described that decreases blood loss secondary to liposuction. The area to undergo liposuction is infiltrated with a cannula of our own design. Epinephrine is not used as a vasoconstrictor but rather L-ornithine 8-vasopressin at a concentration of 0.01 lU/ml chilled saline. With this new technique, the amount of blood removed is minimal, even in the case of extraction of large volumes of fat.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID