Treatment of brown recluse spider bites.
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Aspirin↗
Biomedical subjects
R S Rees
Publications and source records attributed to R S Rees.
Pectoralis major musculocutaneous flaps: long-term follow-up of hypopharyngeal reconstruction.
We have reviewed our experience with 25 patients who have undergone major head and neck resections and required hypopharyngeal pectoralis major flap reconstruction. Six patients were alive 1 year following reconstruction and five patients consented to evaluation of flap function with endoscopy, with biopsy, barium swallow, and esophageal manometrics. The patients were older (61 +/- 6 years) and the flaps were large (42 +/- 9 cm2). Barium studies were the most useful method of evaluating these patients. Postoperative stricture and laryngeal aspiration were found in two patients. Biopsy of the flap demonstrated loss of keratin in the overlying epidermis, while the gross appearance was more like the surrounding mucosa. A review of dietary intake in these cases revealed that two patients weighed less than their preoperative weights, while another refused oral feedings despite a good functional result. Three of five patients preferred gastrostomy feedings to oral alimentation.
Aged↗
Aneurysm of the superficial temporal artery presenting as a parotid mass.
True aneurysms of the superficial temporal artery are rare and are associated with atherosclerosis. If the aneurysm occurs in the proximal portion of the superficial temporal artery, it may present as a parotid mass, encompass the facial nerve, and require superficial parotidectomy, as it did in this patient. Preoperative assessment with ultrasonography was the most useful diagnostic test because the aneurysm was thrombosed and was not visible by angiography. Thrombosed superficial temporal artery aneurysm should be in the differential diagnosis of parotid masses.
Aged↗
Assessment of regional left ventricular function by magnetic resonance.
The ability of magnetic resonance to determine regional left ventricular function was investigated in 18 patients--13 with coronary artery disease (nine with previous infarction), one with congestive cardiomyopathy, one with mitral stenosis, one with an atrial septal defect, and two without detectable cardiac abnormality. Coronal magnetic resonance images were acquired through the aortic valve and sagittal images were acquired in the plane of widest diameter of the left ventricle seen in the coronal image, both at end diastole and end systole. Regional wall motion assessed by magnetic resonance was compared with the results of anteroposterior and left lateral x ray ventriculograms by two independent observers. The left ventricular wall was divided into three segments in each plane and the motion of the segments was classified as normal, hypokinetic, akinetic, or dyskinetic. Muscle thickness was measured in each segment of the magnetic resonance images and was considered to be abnormal if in the systolic images it was less than 75% of that in neighbouring segments or if it failed to increase by at least 25% between diastole and systole. Wall motion assessments by the two methods agreed in 68 of 105 segments analysed, but differed by one class in 32 segments and by two classes in five segments. The differences can be explained by the conditions under which the investigations were performed and by the disparity between a tomographic section and an x ray projection. Magnetic resonance showed 25 segments to have abnormal wall thickness. Only one patient with infarction did not have an area of wall thinning and no patient without infarction had an area of thinning. It is concluded that magnetic resonance allows an accurate non-invasive assessment of left ventricular wall motion and thickness.
Adult↗
Magnetic resonance assessment of aortic and mitral regurgitation.
Magnetic resonance imaging provides an accurate method for the measurement of left and right ventricular volume. The ratio of left ventricular stroke volume to right ventricular stroke volume was calculated from contiguous transverse magnetic resonance images and was used to measure the severity of regurgitation in 18 patients with aortic regurgitation and 10 with mitral regurgitation. Cardiac anatomy was well demonstrated, allowing an assessment of relative chamber volumes and associated abnormalities, although valve abnormality was not well seen. There was a weak correlation between magnetic resonance measurements of left ventricular end diastolic volume and stroke volume ratio. The stroke volume ratio differed significantly in four groups with increasing angiographic severity of regurgitation, and all but the group with trivial regurgitation differed significantly from normal. There was good correlation between magnetic resonance and radionuclide measurements of left ventricular ejection fraction and stroke volume ratio, although the stroke volume ratio was consistently overestimated by radionuclide ventriculography. Correlation was less good for the right ventricular ejection fraction, which was underestimated by radionuclide ventriculography. It is concluded that magnetic resonance imaging provides valuable information in patients with valvar regurgitation, and serves as a suitable standard by which to judge conventional techniques.
Adolescent↗
Tissue expansion: its role in traumatic below-knee amputations.
A case of nonhealing ulcer overlying a traumatic below-knee amputation treated with tissue expansion, excision, and primary closure is presented. Histologic evidence of tissue injury following tissue expansion is presented, and a recommendation for its cautious use in patients with impaired wound healing is suggested.
Adult↗
Altered vitamin A-binding proteins in carcinoma of the head and neck.
Since vitamin A inhibits the terminal differentiation of keratinocytes, elevated levels of cytoplasmic vitamin A-binding proteins could explain the reduced tendency of squamous cell carcinomas to undergo terminal differentiation. The levels of cellular retinol-binding protein (CRBP) and cellular retinoic acid-binding protein (CRABP) were determined in 37 squamous cell carcinomas of the head and neck and were compared with the corresponding levels in adjacent normal tissue. The CRBP levels expressed per milligram of DNA were increased threefold (P = 0.0005) in the tumor as compared with normal tissue. In contrast, CRABP levels expressed per milligram were decreased 2.5-fold (P = 0.0007) in the tumor as compared with normal tissue. Despite significant differences in retinoid-binding protein levels between tumor and adjacent normal tissue, there was no significant correlation of these differences with any of the patient clinical parameters or any of the tumor growth characteristics. The increased CRBP levels may explain why terminal differentiation, an important mechanism for limiting growth in normal keratinocytes, is less readily induced in squamous cell carcinomas.
Adult↗
Dimensional accuracy of magnetic resonance in studies of the heart.
Magnetic resonance (MR) can provide high-resolution tomographic images of the heart at any part of the cardiac cycle. Tests on static and dynamic phantoms showed that the technique can give accurate measurements of ventricular wall thickness, cavity volume, and stroke volume. In 20 patients with angina pectoris, electrocardiographically gated MR images of the left ventricle were compared with X-ray contrast ventriculograms. There was good correlation with the anteroposterior ventriculogram, but poorer correlation in the lateral projection because of difficulty in locating the aortic valve precisely on the ventriculogram. In 20 normal subjects, left and right ventricular volumes at end-diastole and end-systole were measured by summing the areas of the cavities in multiple contiguous sections. Stroke volumes and ejection fractions were thus calculated, and the ratio of left to right ventricular stroke volume was very close to the theoretical value of 1, in all cases. In any individual volume measurement, the error was approximately 2%. MR therefore provides an accurate non-invasive method of studying cardiac dimensions and function.
Animals↗
Heart size in high-kilovoltage chest radiography.
High-kilovoltage (kV) radiography of the chest using an air gap results in magnification of the heart and thorax despite the use of a longer focus-to-film distance. One hundred patients had their recent high-kV chest radiograph compared with their previous low-kV film. There was a significant increase in all cardiac parameters. Geometric distortion of the cardiac shadow also occurred, resulting in magnification and elongation preferentially affecting the left side of the heart. We believe this causes an additional subjective impression of a large heart. Radiologists and clinicians should revalue their assessment of cardiac size when such a technique is used.
Heart↗
Pulmonary mycotic aneurysms secondary to infective endocarditis in a patient with a persistent ductus arteriosus and partial anomalous pulmonary venous drainage.
Mycotic aneurysms are a rare but recognized complication of infective endocarditis. Aneurysms of the pulmonary artery are usually associated with infected congenital heart lesions and especially with persistent ductus arteriosus. This report deals with a patient with a persistent ductus who developed multiple mycotic aneurysms in the right lung following infective endocarditis, and whose management was complicated by anomalous venous drainage of most of the contralacteral lung. Surgical closure of the ductus to reduce pulmonary blood flow failed to prevent haemoptysis, and further surgery to ligate the feeder arteries to the aneurysms was required.
Adult↗
Brown recluse spider bites. A comparison of early surgical excision versus dapsone and delayed surgical excision.
In a prospective study, 31 patients with brown recluse spider bites were treated by either immediate surgical excision or with the leukocyte inhibitor, dapsone, followed by delayed surgical excision. Patients were matched for age, gender, and lesion size and were excluded if the typical history and physical findings were not present. In patients treated with immediate surgical excision (N = 14), delayed wound healing (N = 5) and objectional scarring (N = 7) were common complications. However, pretreatment treatment with dapsone reduced the incidence of wound complications (N = 1) and objectional scarring (N = 1) (p less than 0.05), while reducing the need for surgical excision (N = 1). There were no severe drug reactions due to dapsone, although one patient had persistent G.I. upset. Pretreatment with dapsone not only reduced surgical complications but also improved the outcome of patients bitten by the brown recluse spider.
Adolescent↗
Do brown recluse spider bites induce pyoderma gangrenosum?
Brown recluse spider bites are usually self-limited skin lesions that infrequently progress to bullae, ulceration, and scarring. We treated a patient with a documented brown recluse bite who had recurring lesions resembling pyoderma gangrenosum (PG) that persisted for months. Three other patients referred to Vanderbilt University because of probable brown recluse bite also had pyoderma for the first time after a suspected arthropod bite. The persistent and recurrent pyodermas in these four patients indicate that (1) brown recluse spider bites may not be self-limited but induce PG or PG-like lesions; (2) arthropod bites in general may induce PG in susceptible people; and (3) treatment of the PG-like lesions in these patients may be difficult.
Adult↗
Assessment of bronchiectasis by computed tomography.
Computed tomography and bronchography were used to assess the distribution of bronchiectasis in 15 lungs from eight patients with clinical features of the disease. Of the 36 lobes adequately displayed by bronchography, 22 were found to have bronchiectasis and 14 were found to be normal by both techniques. Cystic disease was readily identified by computed tomography but the cylindrical and varicose types of bronchiectasis could not be distinguished. Segmental localisation was less accurate, with agreement between computed tomography and bronchography in 116 out of 130 segments. It is concluded that with a modern high resolution scanner computed tomography provides a useful method of assessing lobar distribution in bronchiectasis.
Bronchiectasis↗
CT appearance of mycotic aneurysms of the intrapulmonary arteries in the right lung.
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Adult↗
Sacral pressure sores: treatment with island gluteus maximus musculocutaneous flaps.
We have used the island gluteus maximus musculocutaneous flap to cover sacral pressure sores. In this report, we describe the surgical anatomy, cadaveric dissections (n = 25), and postoperative follow-up (one to 40 months) in 13 clinical cases. Our results compare favorably with those of other previously reported series. Postoperative complications are few (n = 2) and late recurrence is acceptable (n = 1). Since the surgical anatomy is consistent and the operative technique simple, this procedure may be the treatment of choice for sacral pressure sores.
Adult↗
Unusual form of bilateral partial anomalous pulmonary venous drainage.
A 23-year-old man with known valvular pulmonary stenosis was found to have a very unusual form of bilateral partial anomalous pulmonary venous drainage. The venous drainage from the upper parts of both lungs was anomalous, draining from the left lung via a persistent left-sided superior vena cava and from the right lung directly into the right atrial/right superior vena caval junction. The venous drainage from the lower parts of both lungs was normal. The embryological pathogenesis of the defect is discussed.
Adult↗
Comparison of blood flow and cell function in ischemic skin flaps.
Cellular function and blood flow in acute, steroid-treated, and surgically delayed random skin flaps have been examined. In these studies, the period following flap elevation could be divided into early (0-2 hr), intermediate (4-6 hr), and late (12 hr) periods of ischemia, based on the cutaneous blood flow and cellular function measured by thallium-201 uptake. There was a close correlation (r = 0.98, 2 hr) between blood flow and cellular function during the early period of ischemia which became worse with time (r = 0.78, 12 hr). Blood flow studies demonstrated a significant difference (P less than 0.05) between the early and intermediate periods of ischemia which was abolished by surgical delay. Improvement in cellular function was accomplished by improved blood flow in the surgically delayed flaps, while steroid-treated flaps enhanced cellular metabolism by another mechanism. Cellular function approximated blood flow during the early and immediate period of ischemia. Steroids may augment cellular function without improving blood flow, while surgical delay improves cellular function by improving blood flow.
Animals↗
Carcinoma of the hand: a 20-year experience.
We reviewed our 20-year experience with cutaneous carcinoma of the hand and identified 70 cases (basal cell 23%, squamous cell 77%). The documented risk factors included solar radiation, trauma, and irradiation. Lesions were treated surgically with amputation, excision, skin graft, or flap closure, and nonsurgically with cryosurgery, curettage, 5-fluorouracil, or irradiation. The recurrence was lower with surgical treatment (3%) than with nonsurgical (33%). Regional lymphadenectomy was required in four patients for metastatic squamous cell carcinoma. Recurrence was greater (9%) and metastasis more common (38%) in patients with Marjolin's type of secondary squamous cell carcinoma than with solar-induced lesions. Cause is an important factor in outcome and should be considered in initial treatment and long-term management.
Adult↗