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Biomedical subjects

S Ariyan

Publications and source records attributed to S Ariyan.

At least 55 records · Page 3Linked to original sources
PubMed1994

Repeated use of the same myocutaneous flap in difficult second operations of the head and neck.

We have found that the pectoralis major myocutaneous flap is so reliable a flap that in seven selected patients we completely re-elevated, isolated, and transposed it to a new reconstructive site in the head and neck. This may be accomplished safely, despite full courses of external-beam radiation therapy to the flap. We discuss the principles of this and propose that it can be extended and applied to other island, pedicle, or free flaps. The manner in which the flap can be reused and integrated with microvascular transfer or other regional pedicle flaps in complex secondary operations must be determined by the individual reconstructive surgeon on the basis of the requirements of the reconstruction. This technique will make one more tool available to the surgeon for reconstruction.

Aged↗
PubMed1993

Mandible preservation with oral cavity carcinoma: rim mandibulectomy versus sagittal mandibulectomy.

Rim mandibulectomy, a mandibular-preserving procedure, has proven to be a successful method of treating squamous cell carcinoma with limited mandibular involvement. The operation involves resection of the occlusal rim of the mandible. Using strain gauge techniques, we investigated how much bone should remain at the rim mandibulectomy site. Maintenance of a 1-cm-thick segment of bone inferiorly is required to reduce the risk of fracture formation. In comparing the relative strength of the different mandibular preservation techniques, the rim mandibulectomy was found to be more resistant to fracturing than was lingual sagittal mandibulectomy.

Carcinoma, Squamous Cell↗
PubMed1993

Data on first recurrence after treatment for malignant melanoma in a large patient population.

Recurrent malignant melanoma is a clinical entity that behaves distinctly differently from the primary disease. The purpose of this study was to determine whether there are significant trends in the prognostic factors or in the timing and sites of recurrence. We reviewed 250 patients with recurrent malignant melanoma from the Sydney Melanoma Unit in Australia who were followed in their Tumor Registry between 1960 and 1981 (median follow-up was 7 years). Fifty-two percent of all first recurrences were to regional nodes, 17 percent were local recurrences, 8 percent were in-transit metastases, and 23 percent of all first recurrences were to a distant organ. We found that 67 percent of all recurrences were diagnosed within 24 months and 81 percent were diagnosed by 36 months after the primary melanoma. Regional nodal recurrences were diagnosed earlier (with 63 percent at 18 months and 74 percent at 24 months). Local recurrences and in-transit metastases were comparable (with 55 percent of each at 18 months and about 66 percent of each at 24 months), and systemic recurrences were diagnosed later (52 percent at 24 months and 71 percent at 36 months). Of significant interest was the fact that survival after the diagnosis of recurrence was independent of thickness of the primary tumor or duration of disease-free interval (local, in-transit, or regional nodal). Only the diagnosis of distant organ metastasis correlated with shorter survival; local recurrence, in-transit metastasis, and regional nodal metastasis were all associated with comparable survivals.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Role of computed tomography in the staging of primary melanoma.

PURPOSE: To evaluate the role of body computed tomography (CT) for the staging of patients with early melanoma. PATIENTS AND METHODS: A total of 151 new patients with American Joint Committee (AJC) clinical stage I, II, and III melanoma who received a CT scan of at least the chest and abdomen are the subject of this study. CT scans considered suspicious for metastases were reviewed again by one of the investigators (A.McB.C.). RESULTS: Of 151 patients, 63 had AJC clinical stage I, 61 stage II, and 23 stage III disease. In addition, one patient each had primary melanoma of the anal canal, esophagus, or vulva. Twenty-nine (19%) of 151 patients had a CT scan that was considered suspicious for metastases. The most common radiologic findings were single hepatic, and single or multiple pulmonary nodules. Of these 29 patients with suspicious scans, 24 subsequently proved to have benign processes by biopsy or follow-up studies, three had second primary tumors (well-differentiated lymphocytic lymphoma, Hodgkin's disease, and renal cell carcinoma), and only two were found to have metastatic melanoma. Of these two patients, one had regional nodal disease (unsuspected on physical examination) and one had distant nodal metastases. CONCLUSION: Body CT is not a useful imaging study in the detection of occult metastases in patients with primary melanoma. Although body CT commonly shows suspicious radiologic abnormalities in patients with early melanoma, these abnormalities most likely represent benign processes or a second primary tumor, rather than metastatic melanoma. The value of body CT in patients who present with nodal metastases needs further study.

Abdominal Neoplasms↗
PubMed1992

Comparison of 180-degree and 360-degree skeletal muscle nerve cuff electrodes.

Use of skeletal muscle for cardiac augmentation is a promising technique for treatment of end-stage cardiac failure. An electrode woven through the latissimus dorsi that recruits nearby nerve fibers is commonly used to pace skeletal muscles both in clinical practice and in the laboratory. A proximally placed nerve cuff electrode offers potential advantages in improved recruitment of muscle fibers and low threshold for stimulation. We tested the effectiveness of a nerve cuff electrode passed directly about the proximal thoracodorsal nerve. Our report looks at the efficacy of nerve cuff electrode stimulation and compares electrical and histologic characteristics of a 180-degree wrap of the thoracodorsal nerve to a 360-degree wrap in dogs over 3 months. Threshold voltage at the commonly used pulse width of 200 microseconds was typically in the range of 400 to 600 mV for each electrode after 3 months. Statistical analysis revealed no significant difference (p < 0.05) in threshold voltage or current between the 180-degree and 360-degree nerve cuff electrode either at acute evaluation or after 3 months. Even contraction of latissimus dorsi was achieved with all implants. Adenosine triphosphatase staining revealed 100% conversion of type II to type I fibers in all stimulated muscles. Histologic examination of the thoracodorsal nerve and latissimus dorsi muscle revealed no abnormalities grossly or by light microscopy. Thus, a carefully applied nerve cuff electrode is an atraumatic, effective method for skeletal muscle stimulation. The 180-degree and 360-degree nerve cuff configurations are equally effective.

Adenosine Triphosphatases↗
PubMed1992

The impact of stress on the clinical presentation of melanoma.

The impact of major life events on the clinical presentation of melanoma was determined in a retrospective case-control analysis. There was a significantly higher occurrence of divorce or marital separation and a significantly higher occurrence of bankruptcy or unemployment in the 5 years prior to the clinical presentation of 56 melanoma patients relative to an age- and sex-matched control group of 56 general surgical patients (p less than 0.01). There was also a higher occurrence of death of a spouse or immediate family member, although this difference was not statistically significant. Overall, 26 (46 percent) of the melanoma patients had major life crises in the 5 years prior to clinical presentation, and this was highly significant (p less than 0.01). We believe that major life stress has an impact on the clinical presentation of melanoma. Potential reasons for this difference are reviewed.

Adult↗
PubMed1989

Scanning electron microscopy and gel electrophoresis of vascularized periosteal autografts.

This study was devised to investigate the morphologic and biochemical sequence of events occurring during early periosteal osteogenesis in vascularized periosteal flaps. A pleuroperiosteal flap based on the intercostal vessels was developed and rotated onto the chest wall in 12 adult dogs. Animals were sacrificed at intervals between 7 and 60 days, and the flaps were removed with the underlying muscular bed. Specimens were studied by tetracycline uptake, gel electrophoresis, light microscopy, and the scanning electron microscope. Osteoprogenitor cells were seen as early as 7 days after transfer. Collagen fiber deposition was vigorous and noted in all specimens with rapid mineralization by 9 to 15 days. There was no structural or vascular interaction between the flaps and the recipient muscular bed. Gel electrophoresis confirmed the presence of type I and III collagen, with an increase in type I collagen over time. The pattern of collagen deposition and the final bony architecture resembled that of woven bone.

Animals↗
PubMed1989

Cutaneous angiosarcoma of the face and scalp.

Cutaneous angiosarcoma is an infrequent but aggressive neoplasm involving the skin of the face and scalp. Unfamiliarity with the clinical manifestations of cutaneous angiosarcoma frequently leads to misdiagnosis and delay in treatment. Complete surgical resection requires the performance of preoperative staging biopsies to determine the true extent of the neoplasm. Intraoperative frozen section analysis to determine the adequacy of the surgical resection is unreliable due to the high false-negative rate. All patients should receive a full course of postoperative radiation.

Aged↗
PubMed1987

A suspensory jacket permitting long-term sitting in paraplegic patients.

A thoracic suspensory jacket has been used in four patients with recurring ischial pressure sores to transfer the site of skin pressure from the insensate ischial area to the sensory area over the rib cage. This modality is not an alternative to surgery, but rather an adjunct to prevent an early recurrence after an ischial pressure sore has been repaired with a proper surgical procedure.

Adult↗
PubMed1986

Radical neck dissection.

This article discusses how the spread of tumor occurs and reviews surgical treatment, including classic and functional radical neck dissection, as well as complications.

Face↗
PubMed1986

Free radial forearm flap versatility for the head and neck and lower extremity.

Microsurgical techniques have developed numerous territories suitable for free tissue transfer. However, the demand for thin cutaneous resurfacing limits the choice of flaps available to the reconstructive microsurgeon. The radial forearm flap is a thin, axial, fasciocutaneous flap, offering pliable cutaneous resurfacing, with or without sensation. We have used 15 flaps to reconstruct defects in the head and neck and lower extremity resulting from burns, blunt and avulsive trauma, radiation necrosis, and tumor ablation. Two flaps (15 percent) developed venous congestion and were salvaged by reoperation. One retrograde flap (7.5 percent) developed partial necrosis from arterial insufficiency. Neural re-innervation was successful in two out of three patients in whom it was attempted. Two patients (15 percent) sustained minor donor site skin graft loss that healed secondarily. In our series of predominantly older patients the donor sites have been relatively inconspicuous at one year follow-up. A functional restoration was achieved in all patients.

Adult↗
PubMed1986

Single-stage repair of complex scalp and cranial defects with the free radial forearm flap.

The free radial forearm flap provides a reliable single-stage method to cover difficult scalp and forehead defects where other local methods are unsuitable. Six patients have been successfully reconstructed utilizing seven free radial forearm flaps. A description of our surgical technique along with illustrative cases demonstrate the indications and advantages of this flap. Cranial soft-tissue deficits are primarily cutaneous; therefore, a more predictable reconstruction can be obtained utilizing a cutaneous flap with similar characteristics. Restoration of bony defects should be considered separately utilizing autogenous bone and/or alloplastic materials and not merely obliterated with a bulky soft-tissue flap. Therefore, if the local factors of a cranial wound require the utilization of a distant tissue transfer, we prefer the thin coverage of a well-vascularized free fasciocutaneous radial forearm flap over two-stage distant pedicle flaps or skin-grafted free flaps.

Aged↗
PubMed1986

Effects of local heat on blood flow in infected and normal hands.

Changes in response to heat in the dermal, subcutaneous, and muscle blood flow in the hands of 10 patients with hand infections were studied using 133Xe and recording of clearance data. A further 15 normal hands were studied in a similar manner. The application of topical heat to normal hands resulted in a decrease in the dermal blood flow (p less than 0.001), an increase in the subcutaneous blood flow (p less than 0.05), and perhaps an increase in the intramuscular flow (p less than 0.1). This suggests that surface heat promotes a shunting of the blood from the skin to deeper tissue layers. In infected hands, the blood flow was found to be significantly increased threefold in the intradermal circulation (p less than 0.01) and eightfold in the subcutaneous circulation (p less than 0.03) when compared to controls. In contrast to normal hands, in the infected hands, the blood flow decreased in all three compartments by 50 percent following application of heat. The blood flow of the normal hand in patients with infection did not respond to heat in the normal pattern. We conclude that the application of local heat to normal tissues results in shunting of blood flow from superficial tissues such as dermis to deeper ones such as subcutaneous fat and muscle. In infected tissues, the blood flow was found to be much higher than normal; however, the traditional belief in the improvement in blood flow by the application of heat was not confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1986

Replantation of a totally amputated ear by means of a platysma musculocutaneous "sandwich" flap.

A total amputation of an ear from an automobile accident was salvaged by suturing the fragments of the skeletonized auricular cartilage and reattaching it to its original position "sandwiched" in a platysma musculocutaneous flap. The anterior portion of this flap was subsequently removed to apply a skin graft to the thin platysma muscle left over the convolutions of the auricular cartilage. This technique represents the application of the principle of bringing blood supply to avascular tissue in order to salvage it.

Adult↗
PubMed1986

Costochondritis: pathogenesis, diagnosis, and management considerations.

The management of costochondritis of the chest wall is reviewed and four illustrative cases presented. Adequate debridement is the single most important factor to ensure eradication of this disease. Well-vascularized tissue coverage reduces ischemic factors, resists secondary infection by contamination, and promotes rapid healing. The pectoralis major, latissimus dorsi, and rectus abdominis muscle flaps are the primary choices for pedicle-flap coverage. Antibiotic coverage was not extended beyond 3 weeks in these cases, and no recurrences have been noted over a 1- to 3-year follow-up.

Actinomycosis↗