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Biomedical subjects

G S Georgiade

Publications and source records attributed to G S Georgiade.

At least 19 recordsLinked to original sources
PubMed1996

Complex radial folds versus subtle signs of intracapsular rupture of breast implants: MR findings with surgical correlation.

Detection of intracapsular rupture of silicone breast prostheses using MR imaging is often performed by identifying the "linguine sign" [1]. The linguine sign is easily differentiated from simple radial folds that are seen in intact implants. However, more subtle signs of intracapsular rupture, including undulating subcapsular lines and the "teardrop sign," are less often recognized [2-5] and may prove difficult for the less experienced radiologist to differentiate from complex radial folds of intact implants. In this essay, we illustrate the MR imaging findings of complex radial folds in intact implants and compare them with findings of incomplete shell collapse in ruptured implants in a surgically confirmed series of explanted silicone breast prostheses.

Breast↗
PubMed1995

Long-term sequelae following median sternotomy wound infection and flap reconstruction.

Use of muscle and omental flaps has been shown to provide reliable reconstruction of infected median sternotomy wounds; however, few reports emphasize the long-term sequelae of the complication and its treatment. This study was performed to evaluate the long-term problems, including patient satisfaction and survival rate, in 88 patients with median sternotomy infections treated with muscle or omental flaps. Forty-two patients were available for long-term follow-up by telephone interview, with an average length of follow-up of 42 months. Forty-three percent complained of chronic chest wall pain or discomfort, and 45% complained of sternal instability. After pectoralis major muscle flap reconstruction in 32 patients, 25% complained of upper extremity weakness, and 56% complained of chest contour deformity. Delayed septic costochondritis or osteomyelitis occurred in 8%. Despite these unfavorable consequences, 72% and 83% of patients were satisfied with the cosmesis of the operation and the overall result, respectively. Furthermore, after hospital discharge, these patients seem to enjoy satisfactory longevity. By emphasizing the potential sequelae, further research interest may be stimulated in delineating their causes and in refining techniques of reconstruction.

Adult↗
PubMed1995

Seromas in residual fibrous capsules after explantation: mammographic and sonographic appearances.

PURPOSE: To evaluate the mammographic and sonographic findings associated with seromas that develop in residual fibrous capsules after explantation of breast prostheses. MATERIALS AND METHODS: Preoperative and postoperative mammograms were reviewed in 86 patients (mean age, 51 years; age range, 24-71 years) who had undergone surgical explantation of breast prostheses. Six seromas were found in four patients 46-68 years of age. Imaging findings were correlated with surgical and laboratory results for three seromas. A presumptive diagnosis was made of the other three lesions. RESULTS: Mammograms demonstrated all seromas as large, elliptic, water-opacity masses, some with well-circumscribed and some with irregular borders. Sonograms showed thin, compressible masses, two of which were flat and anechoic and one of which was hypoechoic. Three patients' images were initially misinterpreted, leading to excision of two seromas and aspiration of one. Seromas were not identified in patients whose implants were removed by means of complete capsulectomy. CONCLUSION: Radiologists must be aware of the imaging findings associated with seromas and of a patient's surgical history to avoid biopsy of benign lesions.

Aged↗
PubMed1993

Management of abdominal aortic graft complications.

OBJECTIVE: This study reviews the outcome of 61 patients who underwent 66 reoperations for complications of aortic grafts. There were 25 patients with false aneurysm of an aortic anastomosis and 41 patients with graft infection, 17 of whom had involvement of the gastrointestinal tract. SUMMARY BACKGROUND DATA: Significant late complications of aortic grafting occurred in 2% of patients. The mode of clinical presentation, the clinical characteristics, and outcome in these patients has not been emphasized. METHODS: This study reviews our experience with patients with complications of aortic grafts requiring graft excision or replacement with a view towards identifying prominent and important clinical characteristics and predictors of successful treatment. CONCLUSIONS: Patients with involvement of the gastrointestinal tract have higher mortality and morbidity than patients with simple aortic graft infection or those who require aortic graft replacement for pseudoaneurysm formation at the aortic anastomosis. These patients require longer hospitalization, more blood transfusion, and have higher operative and long-term mortality. Revascularization of the lower extremities should be attempted and has a high rate of limb salvage although revision or thrombectomy may be required. The authors recommend complete graft excision and extra-anatomic bypass for patients with aortic graft infections.

Aged↗
PubMed1992

Evaluation of the sphincter pharyngoplasty.

The results of the sphincter pharyngoplasty were evaluated in 139 patients with velopharyngeal incompetence (VPI) who demonstrated active velar elevation. All patients underwent perceptual speech evaluation and lateral phonation radiographic study; select patients underwent multiview videofluoroscopic, flexible nasendoscopic, and pressure-flow studies. All but one patient demonstrated improvement and 109/139 (78.42%) demonstrated resolution of VPI. Sixteen of thirty failed pharyngoplasties were revised. Revision was successful in 8/16 patients yielding an overall success rate of 117/139 (84.17%). Success rate was 67.65 percent for patients managed during the first 5 years and improved to 84.78 percent for patients managed during the last 5 years of this 15-year series. Analysis revealed that younger patients were treated more successfully than older patients, large velopharyngeal areas were treated as successfully as smaller ones, and circular closure patterns were treated more successfully than coronal patterns. The primary cause of failure was insertion of the flap below the point of attempted velopharyngeal contact.

Adolescent↗
PubMed1992

Evaluation of failed sphincter pharyngoplasties.

A review of 30 failed sphincter pharyngoplasties is presented. Failure may be caused by inappropriate surgical planning, inadequate surgical technique, or inappropriate patient selection. Problems with surgical planning and technique that lead to failure were low flap placement, flap dehiscence, and flaps not approximated in midline. Problems with patient selection that lead to failure were large velopharyngeal gap on videofluoroscopy, and residual speech (articulation) deficits. Careful pre- and postoperative evaluation has led to refinement of the surgical procedure and improved outcome. Success rate improved from 67.65% in the first 5 years to 86% in the last 5 years of this 15-year series.

Adolescent↗
PubMed1989

The inferior dermal-pyramidal type breast reduction: long-term evaluation.

The evolution of the technique of breast reduction using an inferior dermal pyramidal flap is discussed, including the changes we have found to enhance this procedure. The recommended use of a wide-based pyramidal breast parenchyma with a dermal pedicle nipple-areola flap is based on our 12-year study of 1,001 breast reductions in 519 patients ranging in age from 13 to 73 years; 37 of the patients underwent a unilateral breast reduction. The weight of tissue excised ranged from 207 g to 3,350 g from each breast. Occult carcinomas were found in two of the breast specimens. The longest sternal notch-to-nipple distance was 52 cm. The essential goals of predictability of the result, retainment of nipple sensitivity, excellent aesthetic results, and the possibility of lactation are satisfied by the use of this surgical technique. This technique appears to have continued application in younger women, in whom nipple sensation and lactation are particularly important.

Adult↗
PubMed1988

Factors improving survival in multisystem trauma patients.

This report analyzes the effect of air versus ground interhospital transport on survival following multisystem injury. There were 136 air-transported patients versus 194 ground-transported patients. The groups were similar in trauma scores, ages, mechanism of injury, and organ systems injured. There was a statistically significant survival advantage for air-transported patients with trauma scores between 10 and 5 (82.8% survival vs. 53.5%, p = less than 0.001). The time interval between accident and admission to the authors' institution was similar for both groups. Important therapeutic interventions contributing to better survival by the air-transported group included higher incidences of endotracheal intubation (50% vs. 25%), blood transfusions (32% vs. 10%), larger volumes of electrolyte fluid (3.3 L per patient vs. 2.1 L per patient) as well as the use of MAST trousers (60.3% vs. 34.9%). Transport charges for both ground and air services were similar. However, helicopter charges met only 15% of the operational budget of the aeromedical service. The remainder of the costs were generated from hospital patient revenues. Overall, total hospital charges were similar for both groups and were influenced by the variability of length of stay, particularly for orthopedic patients.

Aircraft↗
PubMed1988

Mammary implants, diving, and altitude exposure.

Mammary implants were exposed to various simulated dive profiles followed by altitude exposures to stimulate aircraft travel and then were observed for bubble formation and volume changes. Minimal volume changes occurred after each dive. Numerous bubbles formed, however, reaching their maximum size in 3 hours. By comparison, when implants were exposed to high altitude following a dive exposure, significant volume changes occurred. This in vitro study showed that bubble formation and volume expansion occur after exposing implants to diving and altitude, but the circumstances required to produce these changes in vivo are extremely unlikely to occur normally.

Altitude↗
PubMed1987

The orticochea pharyngoplasty and primary palatoplasty: an evaluation.

A primary Orticochea pharyngoplasty with a primary palatoplasty was studied in 15 children with cleft palates. Although all children demonstrated velopharyngeal competence, radiographic, endoscopic, and oral examinations suggested that 54% of the children studied would not have needed a pharyngoplasty. In addition, 27% of the children demonstrated aberrant speech patterns associated with velopharyngeal incompetence. Emphasis is placed on the difficulty in identifying which cleft palate patients will have residual velopharyngeal incompetence and the need for continued study and development of techniques for more accurate prediction of which patients would benefit from a primary pharyngoplasty.

Child, Preschool↗
PubMed1986

Chain saw injuries to the face.

Chain saws may produce devastating facial injuries when the blade kicks back after striking a hard object. A review of experience with 12 male patients indicates that in addition to extensive ragged lacerations of skin and soft tissues, bone and teeth are frequently fractured. Eye injuries are rare, but the eyelids may be extensively damaged. Management includes debridement and exploration of the wounds, repair of soft tissues, removal of fractured roots, and application of arch bars if the jaw is fractured.

Facial Bones↗
PubMed1986

An aesthetic approach for nasal tumors.

An elongated columella flap has been found to give excellent exposure to the nasal dorsum, allowing satisfactory removal of soft tissue nasal masses such as dermoid cysts or hemangiomas. This approach provides a more acceptable scar than the standard vertical dorsal nasal incision.

Child, Preschool↗
PubMed1985

Cherubism.

Cherubism is a rare, hereditary fibroosseous lesion of the jaws that is thought to undergo spontaneous involution after puberty. Treatment is unnecessary unless functional or emotional disturbances develop. This article describes the 21-year follow-up of a patient with cherubism and briefly reviews the pertinent literature.

Adolescent↗
PubMed1985

To share or not to share.

We describe our extensive experience in nipple reconstruction on breasts formed by subpectoral implants, latissimus dorsi musculocutaneous flaps, or rectus abdominis musculocutaneous flaps.

Breast↗
PubMed1985

A rationale for the treatment of difficult basal cell and squamous cell carcinomas of the skin.

During a 56-month period, 1,348 patients with either basal cell or squamous cell carcinoma of the skin underwent microscopically controlled excision (Mohs' fresh-tissue technique) by a dermatologic surgeon. Of these 1,348 patients, 394 required various types of wound reconstruction by a plastic surgeon. The average dimensions of these wounds were 5 X 3.5 cm, with a range of 1.5 to 20.0 cm in diameter. There were postoperative complications in 13.9% of the 394 patients. The recurrence rate in these 394 patients, to date, for basal cell carcinoma is 5.2% and for squamous cell carcinoma, 11.9%. The advantages of this treatment arrangement include maximum conservation of normal tissue with provision of more reliable complete tumor excision, optimum time utilization by both dermatologic and plastic surgeons, separation of the responsibility for tumor ablation from that for wound reconstruction, and, in many instances, economic savings. We recommend this method of management for difficult, high-risk basal cell or squamous cell carcinomas.

Adult↗
PubMed1985

Long-term clinical outcome of immediate reconstruction after mastectomy.

Immediate reconstruction of a breast removed for treatment of carcinoma can be accomplished without altering the cancer-ablative surgical procedure. The theoretical possibility that reconstruction might compromise the cure rate has tempered enthusiasm for this approach. To test this issue, the relapse-free survival of 101 patients who underwent breast reconstruction in the immediate postmastectomy period was compared with that of 377 patients with breast cancer who underwent mastectomy without immediate reconstruction. This comparison was accomplished using multivariable statistical techniques to correct for baseline inequalities between the patient groups. After adjustment for the relevant prognostic factors, no significant difference remained between the two groups. We conclude that immediate reconstruction has no discernible adverse influence on the natural history of surgically treated breast carcinoma.

Adult↗