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Biomedical subjects

R N Matthews

Publications and source records attributed to R N Matthews.

At least 37 records · Page 2Linked to original sources
PubMed1988

Reconstruction of the pharynx after laryngectomy and partial pharyngectomy.

Stricture formation may occur after pharyngolaryngectomy if less than one half of the circumference of the pharynx is available for primary closure. However, the alternative of total pharyngectomy with skin flap or visceral replacement carries with it a high mortality and morbidity rate. In an attempt to overcome these problems, a policy of patch grafting the pharyngeal defect with a myocutaneous flap or segment of free vascularised jejunum has been adopted whenever a strip of pharyngeal mucosa greater than one centimetre in width remains after excision of the tumour. A good post-operative swallow has been achieved in all cases.

Aged↗
PubMed1987

Multiple seagull flaps for digital contractures in electrical burns.

Following legislation in the early 1970s, electrical bar fire burns are much less common in the UK than 20 years ago. However, their long-term effects are still encountered as microdactyly, syndactyly and digital flexion contractures. A case is described in which multiple seagull flaps were used as a single stage procedure to achieve sustained improvement in function in a severely affected hand, 10 years after injury, without prolonged postoperative daytime splintage.

Burns, Electric↗
PubMed1987

Transfusion-dependent beta-thalassemia: in vitro characterization of peripheral blood multipotential and committed progenitor cells.

Conditions for the in vitro culture of multipotential and committed progenitor cells obtained from the peripheral blood of transfusion-dependent beta-thalassemic individuals have been determined. When stimulated by either human placental-conditioned medium (HPCM), phytohemagglutinin-stimulated leukocyte-conditioned medium (PHA-LCM), or U5637-conditioned medium and erythropoietin, colonies containing neutrophils, neutrophils and macrophages, macrophages, eosinophils, erythroid cells, or mixtures of erythroid cells and neutrophils, eosinophils, or macrophages were obtained in cultures of beta-thalassemic mononuclear cells. Removal of adherent cells from beta-thalassemic peripheral blood demonstrated the presence of cells capable of the autostimulation of all of the above colony types in the presence of erythropoietin. In addition, adherent cells also appeared to inhibit erythropoiesis in cultures stimulated with HPCM. In cultures of nonadherent beta-thalassemic mononuclear cells, one population of BFU-E was stimulated by erythropoietin and a second required both erythropoietin and HPCM. Titration of erythropoietin, in the presence of optimal stimulation by HPCM, showed that beta-thalassemic peripheral blood BFU-E were more responsive to erythropoietin than was normal peripheral blood BFU-E. Stimulation of multipotential cells in cultures of nonadherent mononuclear cells was dependent upon HPCM. Using these culture conditions, the studies show that, compared with normals, the peripheral blood of transfusion-dependent beta-thalassemic patients contain elevated numbers of multipotential and committed progenitor cells, and that splenectomy did not account for the elevated numbers of these cells.

Cells, Cultured↗
PubMed1986

Early tissue expansion to close a traumatic defect of scalp and pericranium.

A case is presented in which an extensive area of traumatically denuded skull bone was successfully closed using a tissue expanded, hair-bearing scalp rotation flap, following expander insertion on the third day after injury. No split skin grafting was required and, in view of the high quality of cosmesis achieved, it is recommended that the technique be considered for other cases of acute traumatic soft tissue loss.

Adult↗
PubMed1986

The role of filtration in the provision of leukocyte poor red cells to multitransfused patients.

Five techniques for the preparation of leukocyte poor red cells were investigated to compare their efficiency in preventing febrile transfusion reactions with their cost of production, in order to establish a cost-effective transfusion programme for chronically anemic patients. Leukocyte depletion and preparation costs per unit for the products were:--microaggregate filtered red cells (MF): 25% leucocyte removal at a cost of $A2; buffy coat poor red cells (BCP): 70% at $A2; washed buffy coat poor red cells (WBCP): 88% at $A28; cotton wool filtered red cells (CWF): 93% at $A23; reconstituted frozen red cells (FC): 97% at $A80. The 5 products were transfused into 103 thalassemia patients with a documented history of febrile transfusion reactions. Reaction rates, expressed as a percentage of units transfused over a 12 mth period (MF 7%, BCP 0.3%, WBCP 0.1%, CWF 0.1%, FC 0.2%) correlated well with the degree of leukocyte depletion. The cost of CWF was reduced by a further 10% using the filter in line during the transfusion. Serum from these patients was screened for leukocyte and platelet antibodies using microlymphocytotoxic, granulocyte immunofluorescence and platelet immunofluorescence assays. There was no correlation between the antibodies present and the type of leukocyte poor product required by a patient to prevent a febrile reaction. A progressive regimen of transfusion (BCP to CWF to FC as the patient reacts) has now been adopted, with considerable cost saving.

Blood Platelets↗
PubMed1985

Radial forearm flap for floor of mouth reconstruction.

Approaches to reconstructing floor of mouth defects are reviewed including methods of bony reconstruction following mandibular resection. The place of the free radial forearm flap, incorporating vascularized hemiradius if necessary, is described together with the anatomy, operative technique and a review of seven cases. It is concluded that this flap is an important addition to current methods of reconstructing substantial intraoral soft tissue defects alone or associated mandibular defects as well, owing to the high quality of results and to its low morbidity.

Adult↗
PubMed1985

Aspects of mandibular reconstruction.

We present in this paper the indications for bony reconstruction following mandibular resection, together with evaluation of the reconstructive techniques available. Case reports illustrate methods we have found satisfactory and are followed by our recommendations for their specific use.

Aged↗
PubMed1984

Antenatal intrauterine diagnosis of fetal thalassaemia.

The results are reported of the intrauterine diagnosis of fetal thalassaemia in 72 pregnant women investigated during the six years from 1977 to 1982. In the majority of cases fetal blood was collected by fetoscopy for globin chain synthesis at 18 to 19 weeks' gestation. Adequate fetal blood samples for the diagnosis of the thalassaemia status of the fetus were obtained in 85% of cases. The technical difficulties associated with fetoscopy and fetal blood collection are discussed, and the maternal and fetal complications of the procedure described.

Blood Chemical Analysis↗
PubMed1984

Experience with the radial forearm flap in 14 cases.

In 14 cases aged 9-79 years the radial forearm flap has been used for reconstruction. Of 4 island flaps, 2 were distally based (1 with nerve anastomosis) and 2 proximally based (1 innervated). Of the free flaps, 7 were for intra-oral lining following major resection and 3 of these included hemi-radius for mandibular reconstruction. Most flaps were put into a hostile environment resulting from chronic infection and/or radiotherapy or fast neutron therapy. Two flaps failed including one osseocutaneous free flap. Important anatomical, pre-operative and operative aspects are considered, including a description of the timed Allen test, and potential pitfalls and refinements are described.

Adult↗
PubMed1982

Treatment of acute myeloid leukaemia in children.

Complete remission was achieved in 11 of 22 children with acute myeloid leukaemia using at least two courses of a 24 hour infusion of cytosine arabinoside (Ara-C) 10 mg/kg, followed by push injections of daunorubicin (DNR) 45 mg/m2, and adriamycin (ADR) 45 mg/m2. Consolidation therapy consisted of three courses of Ara-C and 6-thioguanine (Tg) and one course of cyclophosphamide (CPA) and ADR. Central nervous system prophylaxis with intrathecal Ara-C was given in all patients and cranial irradiation of five. Maintenance therapy consisted of 5 day courses of Ara-C and Tg given 4 weekly with immunotherapy (BCG) vaccine and subcutaneous leukaemic cells) between courses. Median length of first complete remission was 99+ weeks, and median survival of all patients was 44 weeks. Median survival of remitters was 195+ weeks and non-remitters, 28 weeks. Two patients developed central nervous system disease, one at presentation and the other 46 weeks from presentation. Five patients have ceased therapy and remain in remission from 32 to 142 weeks after ceasing treatment.

Adolescent↗
PubMed1982

Obstetric implications of burns in pregnancy.

Analysis of 50 patients with burns in pregnancy has allowed the objective consideration of obstetric implications. Patients in the second and third trimester of pregnancy with burns of greater than or equal to 50% should be delivered immediately as maternal death is otherwise certain and fetal survival rate is not improved by waiting. Vaginal delivery has always proved possible, even in the presence of perineal burns but caesarean section should be considered and may be preferred. Patients in the first trimester may survive with more extensive burns and possible reasons for this are discussed. Pregnancy testing on admission should be mandatory in burns of women of reproductive age. In patients with burns of less than 40% in the second and third trimesters, spasmolytics should be used to suppress spontaneous labour and to cover operations. Greater fetal maturity without worsening maternal prognosis can thus be achieved. Insufficient data exist to recommend this for burns of between 40 and 50%.

Acute Disease↗