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Biomedical subjects

D A Hudson

Publications and source records attributed to D A Hudson.

At least 19 recordsLinked to original sources
PubMed2003

Malignant melanoma in South Africans of mixed ancestry: a retrospective analysis.

Little is known about the behaviour of melanoma in patients of mixed ancestry. A retrospective analysis of 844 consecutive patients presenting with melanoma over a 12-year period was performed. Forty patients (4.8%) were of mixed ancestry. The data evaluated included patient age, gender, delay in presentation, presenting stage, anatomical distribution, histology, management and outcome. The mean age at presentation was 52.8 years. Twenty-seven patients were female. The mean delay in presentation was 1.54 years. Seventy per cent of melanomas were confined to the extremities, of which one-third were plantar in origin. The most common histological variant, affecting 13 patients (32.5%), was acral lentiginous melanoma; 12.5% of patients presented with in situ (Stage 0) disease, 17.5% with Stage I disease, 22.5% with Stage II disease, 27.5% with Stage III disease and 7.5% with Stage IV disease. Twenty-seven patients (67.5%) remained alive at the end of the study after a median follow-up of 5.58 years, whilst 11 (27.5%) died after a median of 2.42 years. The median survival was 3.92 years. Although the histological type and anatomical distribution reflect the disease pattern of black populations, the overall 5-year survival of 74% is similar to that seen in white populations. An education programme is needed to improve melanoma awareness in mixed race populations.

Adolescent↗
PubMed2001

Short-scar breast reduction: why all the fuss?

The breast can be considered conceptually as a cone. This article compares and contrasts short-scar breast reduction techniques with inverted T techniques using the cone model. Four issues are examined-the base of the breast, breast projection, the inframammary fold, and the pedicle. The short-scar techniques focus on reshaping the breast parenchyma, and skin redraping occurs secondarily. Application of this model suggests that these techniques have the advantage of better projection and greater longevity. These techniques seldom give a square shape and are better at dealing with upper pole deficiency. However, the ability of the skin to redrape is the limiting factor; hence, results are less predictable with large-volume breast reductions. The emphasis of this article is on increasing the understanding of the mechanics of breast reduction. It is this factor that will enable appropriate selection of a particular technique.

Breast Diseases↗
PubMed2001

Serial tissue expansion for reconstruction of burns of the head and neck.

There is little reported on serial tissue expansion for reconstruction of burns of the head and neck. Fourteen children (mean age 7.8 years, range 3-11 years) treated over almost an 11 year period, had a total of 67 expanders used. Fourteen children had expansion performed on the first occasion, 14 again on a second occasion, 10 on a third occasion and one on a fourth occasion. The major complication rate (expander extruded prior to completion of the expansion process) was 21,25 and 14%, respectively. In all cases, the burn scar was completely excised or reduced in size. Serial tissue expansion should be considered as a useful method of reconstruction burns of the head and neck.

Africa↗
PubMed2001

The prognostic importance of c-myc oncogene expression in head and neck melanoma.

Melanomas of the head and neck have a poorer prognosis than melanomas arising at other cutaneous sites. To study the biology of this disease, the expression of the c-myc oncogene was studied in tumors from 97 patients with head and neck melanoma using the technique of flow cytometry. Survival analysis revealed that stratification of patients according to oncogene expression provided a prognostic marker with shorter overall survival in tumors with high nuclear c-myc oncoprotein positivity (log-rank test, chi2 = 8.77, p < 0.005). Multifactorial analysis using Cox's proportional hazards model revealed nuclear c-myc oncoprotein to be an independent prognostic marker (log-rank test, chi2 = 8.82, p = 0.005). These results support the authors' previous studies of the prognostic value of c-myc expression in melanoma and suggest that estimation of c-myc oncoprotein may be of clinical importance in identifying high-risk patients.

Adolescent↗
PubMed2001

Intrauterine stab leading to a radial nerve palsy.

Penetrating injuries to the gravid uterus are rare. This report documents a fetus that sustained a complete radial nerve palsy (a hemopneumothorax) after a knife wound (complete nerve transection is suspected). Surgical exploration of the nerve was delayed because of respiratory distress. Six weeks later, when exploration was scheduled to be undertaken, some recovery was noted, and exploration was thus deferred. The injury recovered completely in the absence of formal repair.

Adult↗
PubMed2001

Aesthetic modification for delayed autologous breast reconstruction: using a thoracodorsal flap to create a breast pocket.

Many patients still undergo delayed breast reconstruction. Although advances in transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction have led to the achievement of a satisfactory shape, the aesthetic result is often marred by the obvious color and texture differences between the abdominal skin and the breast. After mobilizing the mastectomy flaps, the author raises a thoracodorsal flap, which creates a "breast pocket" that is filled with a deepithelialized TRAM flap. This technique has been used in three patients. The advantage of this technique is that it enables a better "aesthetic" reconstruction in that the color and texture of the breast skin is better than that obtained with the abdominal skin from the TRAM flap. The disadvantage of this technique is a slightly longer procedure and the presence of an extra scar.

Breast↗
PubMed2001

Single-stage, autologous breast restoration.

The skin-sparing mastectomy, when performed with immediate reconstruction, is a major advance in breast reconstruction. Traditionally, reconstruction of the nipple-areola complex is performed as a subsequent procedure. In this study, 17 patients (mean age, 43 years; range, 35 to 53 years) underwent one-stage breast and nipple-areola reconstruction over a 21-month period. In all cases of breast reconstruction, a buried transverse rectus abdominis musculocutaneous (TRAM) flap was used, and all patients had a simultaneous nipple-areola complex reconstruction performed. Nine patients had a Wise keyhole pattern used and contralateral reduction performed. Four patients retained all their breast skin, and a TRAM skin island was used in another four. It has recently been shown that patients with early-stage breast cancer and peripherally sited tumors have a very low risk of nipple-areola involvement. In 10 patients with early disease and peripheral tumors, the areola was retained (as a thin full-thickness graft), but more recently, in three patients with early-stage disease, the entire nipple-areola complex was used as a thin full-thickness graft. The thin full-thickness skin graft is removed from the breast in an apple-coring fashion, so that most of the ducts are retained as part of the mastectomy specimen. (There was histological confirmation of absence of tumor in the nipples of these patients.)One-stage autologous reconstruction should be considered for all patients undergoing immediate breast reconstruction. In patients with early-stage disease and peripheral tumors, the nipple-areola complex may be retained through the use of a thin full-thickness graft that is applied to a deepithelialized CV flap on the TRAM flap. This allows the best method of nipple-areola complex reconstruction: by retaining the original breast envelope, the color match and texture in the reconstruction are ideal. Patient satisfaction in this study was high. Necrosis of the mastectomy flaps impaired the cosmetic results in some patients. A large multicenter study is required to confirm the effectiveness of this procedure.

Adult↗
PubMed2000

Tissue expansion for frontal hairline restoration in severe alopecia in a child.

Burn alopecia has serious sequelae, both aesthetic and psychological, particularly in children. A case of 70% scalp alopecia due to a flame burn, and the modality of treatment is described. This consisted of an expanded temporo-parietal flap, which was transposed to create a frontal hairline. A relatively simple surgical procedure had both substantial aesthetic, and psychological benefits.

Alopecia↗
PubMed2000

Cooling the burn wound: evaluation of different modalites.

A study was undertaken to investigate the cooling and healing effect of different modalities: Melaleuca Alternifolia Hydrogel (Levtrade International (Pty) Ltd.) was compared with tap water as a coolant following application onto a fresh deep partial thickness hot water burn in a porcine model. Four identical circular scalds were created on the backs of 10 pigs. One wound was not treated and served as a control. The other 3 wounds were either cooled with tap water (15 degrees C) or had Melaleuca Hydrogel dressing applied immediately, or after a 30 min delay. Intradermal temperatures were monitored in all wounds: preburn, during the burn and at regular intervals for 1 h. The wounds were biopsied for histological assessment. These samples were repeated at 24 h and 3 weeks. The mean decrease in final temperature at 1 h was in comparison to the preburn temperature; control +0.44 degrees C (i.e. a temperature increase); water -7.82 degrees C; Melaleuca Hydrogel -3.87 degrees C; Melaleuca Hydrogel after 30 min delay -2.67 degrees C. Clinical and histological assessment at 21 days indicated more rapid healing in both the Melaleuca Hydrogel and water-cooled burns compared with the untreated controls. Effective cooling of the burn wound and an increased rate of wound healing was achieved by both repeated tap water compresses and by immediate or delayed application of Melaleuca Hydrogel. Cooling is an effective means to reduce tissue damage and increase wound healing.

Administration, Topical↗
PubMed2000

An analysis of p16 tumour suppressor gene expression in acral lentiginous melanoma.

Acral lentiginous melanoma is a particularly aggressive melanocytic lesion but, due to its comparative rarity, biological investigations into the behaviour of this subtype of melanoma are lacking. The activity of the recently described p16 tumour suppressor gene, thought to be the 'familial melanoma gene', was studied in 24 patients with subungual melanoma and 44 patients with plantar melanoma. Lower levels of p16 oncoprotein were demonstrated than that found in other histogenetic types of melanoma. Stratification of patients of all disease stages revealed a poorer survival in patients with low p16 expression (log rank test, chi(2)= 3.9, P = 0. 05). These data suggest that p16 inactivation may play an important role in the development and progression of acral lentiginous melanomas. However, the level of p16 expression was not prognostic since survival analysis on stratification of stage I patients according to p16 level did not reach statistical significance for both survival and disease free interval.

Aged↗
PubMed2000

Chronic axillary hidradenitis--the efficacy of wide excision and flap coverage.

A number of different modalities of surgical treatment for axillary hidradenitis suppurativa have been suggested. This study compares three different methods of surgical excision. Fifty-nine patients (94 axillae) were treated over a 14-year period. There were 42 females and 17 males with an average age of 32 years (range 16-65 years). Twenty-six axillae had excision of only the diseased skin and recurrent disease occurred in seven. However, in 39 axillae that were treated by excision of all the hair bearing skin, only three developed recurrent disease, which is a significant reduction in the incidence of recurrent disease (P = 0.04, Fischer's exact test). Twenty-nine axillae were treated by wide local excision (2 cm beyond the hair bearing skin) and no recurrence occurred. However, there was no statistical difference (P = 0.18, Fischer's exact test) in disease recurrence between excision of all the hair bearing skin and wide local excision. This study suggests that excision of all the hair bearing skin is the preferred method of surgical treatment. Flap coverage was an effective method to achieve wound closure after adequate excision and can be achieved by random fasciocutaneous flaps for small or medium sized defects and parascapular flaps for large defects.

Adolescent↗
PubMed2000

Hands off!

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Fracture Fixation↗
PubMed2000

Penile lengthening for traumatic penile amputation due to ritual circumcision: a case report.

Some tribes in South Africa still practice ritual circumcision in adolescent boys. A traditional healer performs the procedure and, not uncommonly, amputation occurs. The authors present a case of a 20-year-old man who sustained a midshaft penile amputation as a result of a ritual circumcision. Treatment was with a modified penile-lengthening technique that incorporates gracilis muscle transposition to fill the dead space created after detaching the penile suspensory ligament. This may help prevent retraction. Almost 3 cm of lengthening was obtained. This is a useful method of treatment for penile amputation.

Adult↗