Biomedical subjects
Publications and source records attributed to H Edington.
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Biologic therapy has evolved as a fourth treatment option for patients with melanoma and other malignancies. Interrelated advances in molecular diagnostics and gene therapy techniques will further accelerate therapeutic advances in this new arena. A variety of biologic therapeutic options available to the patient with high risk melanoma are reviewed.
Gene therapy, the science of altering cellular function or structure at a molecular level, is currently one of the most exciting fields of research across medical specialties. By replacing lost or defective genes or adding genes known to produce proteins with beneficial effects, investigators hope to treat and possibly cure everything from inborn errors of metabolism to acquired diseases, such as emphysema and atherosclerosis. Genetic modification of engineered tissue, the offspring of these two fields, offers the promise of not simply replacing tissue, but improving on the restoration. The studies presented in this article demonstrate many of the principles that form the basis of gene therapy and provide insight into the potential of this emerging technology.
OBJECTIVE: To determine whether intraoperative lymphatic mapping with isosulfan blue dye and sentinel lymph node biopsy accurately demonstrates the pathway of regional metastases from mucosal sites in squamous cell carcinoma of the head and neck. DESIGN: A prospective clinical study of intraoperative lymphatic mapping. SETTING: An academic tertiary referral center. PATIENTS: Patients with previously untreated squamous cell carcinoma of the head and neck whose surgical treatment included neck dissection. INTERVENTION: Injection of isosulfan blue dye into the mucosa surrounding squamous cell carcinomas of the upper aerodigestive tract during cervical lymphadenectomy. OUTCOME MEASURES: Correlation of the pathologic findings in the blue sentinel lymph node with those in the remaining cervical lymphatics. RESULTS: No blue-stained cervical lymphatics were identified after injection of the mucosa surrounding the primary squamous cell carcinoma with isosulfan dye. CONCLUSION: The technique of intraoperative lymphatic mapping with isosulfan blue dye requires further study before it can be used for the detection of occult cervical metastases in squamous cell carcinoma of the head and neck.
BACKGROUND: Abdominal wall dehiscence with an associated enterocutaneous fistula is a surgical complication with high morbidity and mortality. Management of the abdominal wall defect is complicated by the continued emergence of liquid bowel contents. PATIENTS AND METHODS: Large abdominal wall wounds of 10 patients with postoperative abdominal wall dehiscence and active enterocutaneous fistulae were managed with early skin grafting directly onto the granulated abdominal viscera. RESULTS: Skin graft take averaged 93 +/- 12%, and there were no perioperative complications related to the skin grafting procedure. Overall mortality was 1 out of 10 patients. Enterocutaneous fistula output did not prove overly injurious to the skin grafts. Wound care was simplified in all but 1 patient with fitting of an ostomy appliance. CONCLUSION: Temporary abdominal wall wound closure with skin grafts improved patient comfort and simplified wound care in a staged reconstructive approach to this surgical complication.
We describe a simple technique to facilitate the primary closure of skin defects. Skin, subcutaneous tissue and fascia are undermined as a unit on both sides of the defect. Fascial releasing incisions are performed, creating two bipedicled fascial flaps attached to the overlying skin. The fascia is approximated, if possible, and the skin sutured. We believe this technique offers a number of advantages and results in a superior closure to that obtained with the conventional method of skin undermining. This approach has enabled the closure of 10 of 11 medium sized wounds.
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BACKGROUND: A multidisciplinary wound care clinic was established to diagnose and treat patients with nonhealing ulcers of the lower extremity. METHODS: The clinic was organized under the direction of the departments of vascular surgery and dermatology with support by the departments of plastic surgery, hyperbaric medicine, orthopedic surgery, and podiatry, and a research nurse. RESULTS: In the first 4 years and 3 months, 683 patients were evaluated. One hundred seventy-one patients underwent outpatient testing in the noninvasive vascular laboratory and 30 patients underwent angiography. Causes of the ulcers were venous stasis, 280 patients (41%); diabetic neuropathy, 182 patients (27%); arterial insufficiency, 119 patients (17%); rheumatologic disorders, 38 patients (6%); trauma, 15 patients (2%); and in 49 patients (7%) a variety of other disorders. One hundred seventy-nine operations were performed including 86 operating room debridements, 48 amputations (43 toe, 4 below knee, 1 above knee), 23 arterial bypasses, 1 venous bypass, 14 skin grafts, 2 pedicle flaps, and 5 excisions of tumor. Fifty-six patients with cellulitis were admitted to the hospital for intravenous antibiotics and 12 patients were treated with hyperbaric oxygen therapy. One-hundred thirty-two patients were entered into randomized prospective trials of topical growth factors on Institutional Review Board approved protocols. CONCLUSIONS: We concluded that a multidisciplinary approach to wound care is beneficial to patients with chronic wounds and provides a mechanism for clinical investigation on the healing of problem wounds.
Recent experimental work has suggested that increased lip pressure and scar contraction following lip repair with wide soft-tissue undermining may, in part, contribute to midfacial growth inhibition. The present study was designed to test this hypothesis through the application of pharmacologic agents reported to minimize scar contraction. Thirty-six 6-week-old rabbits were divided into six groups: unoperated controls, rabbits with surgically created defects left unrepaired (surgical controls), and four groups of rabbits with surgically created defects with lip repair and wide undermining on the maxillary surface. Animals with lip repair received either no injections or labial subcutaneous injections of distilled water (route-of-injection controls), normal saline, or papaverine hydrochloride for 2 weeks postoperatively. Rabbits with lip repair and saline or papaverine injections showed significantly (p less than 0.05) decreased lip pressure, relatively hypotonic orbicularis oris muscle EMG activity on the cleft lip side, and greater anteroposterior facial growth (assessed radiologically) from 2 to 24 weeks postoperatively compared with rabbits with lip repair and postoperatively compared with rabbits with lip repair and no injections or distilled water injections. Preliminary results suggest that wound contraction following lip repair and soft-tissue undermining may contribute to mid-facial growth inhibition, which may be reduced by pharmacologic manipulations in the rabbit model.
While the appearance of a mediastinal mass in a patient in remission from Hodgkin's disease frequently indicates recurrence, a number of benign processes may present in a similar manner. Tissue confirmation of relapse should be obtained prior to initiating further chemotherapy to avoid the morbidity of unnecessary treatment. We present a case of thymic hyperplasia that developed in a patient previously treated for Hodgkin's disease. Thymic hyperplasia is a poorly understood, apparently benign process that may be confused with recurrent lymphoma. Total excision of such a mass is recommended to rule out coexistent malignancy.
To evaluate the relationship of toxicity of doxorubicin to route of administration, we studied 21 mongrel dogs which were randomly assigned to one of three groups: 1) a control group undergoing intraatrial indwelling catheter placement but no drug therapy; 2) an IV group receiving weekly doxorubicin by peripheral IV bolus administration; and 3) a catheter group receiving weekly doxorubicin through an indwelling intraatrial catheter. After 8 weeks all dogs were evaluated hemodynamically and then sacrificed. Sections of right ventricle were evaluated by light and electron microscopy. Although no hemodynamic alterations were found in any of the three groups, significant ultrastructural damage consistent with doxorubicin cardiac toxicity was demonstrable in four of the six evaluable catheter dogs receiving intraatrial doxorubicin, but in none of the other 13 dogs evaluated. This finding suggests that the intraatrial administration of doxorubicin may lead to cardiac toxicity at a lower cumulative dose than noted with peripheral IV administration.
Needle catheter jejeunostomy is a useful method for providing fluid and nutritional support in selected patients after laparotomy. The technique is widely used, and complications are infrequent. We report herein a new complication of this procedure. A cirrhotic patient with portal hypertension underwent needle catheter jejeunostomy subsequent to esophageal transection for esophageal hemorrhage. The catheter functioned satisfactorily in the postoperative period and was removed before discharge. Approximately 1 yr later, gastrointestinal hemorrhage recurred which was localized to the site of the previous needle catheter jejeunostomy. Portasystemic collaterals between the small bowel and the abdominal wall at the jejeunostomy were the source of bleeding. Take-down of the jejeunostomy site and resection of the involved bowel successfully controlled hemorrhage. Needle catheter jejeunostomy may be contraindicated in patients with portal hypertension.