Biomedical subjects

S Ariyan

Publications and source records attributed to S Ariyan.

At least 73 records · Page 4Linked to original sources

PubMed1985

Intraoperative adjuvant radiotherapy for advanced cancers of the head and neck. Preliminary report.

We have reported the early local control and survival results of treatment of recurrent or metastatic head and neck tumors with intraoperative brachytherapy. All six patients were locally free of disease after curative surgery and intraoperative brachytherapy for 4 months to 1 year, whereas two of eight patients were alive at last follow-up at 7 and 8 months with some complications after palliative surgery and intraoperative brachytherapy. We advocate such a technique not only in hopelessly advanced tumors but also in less advanced tumors, as well as a definitively integrated plan of management. Doses of iodine-125 of up to 15,000 rads are safe and well tolerated, even in the presence of a past history of radiotherapy.

Brachytherapy↗

PubMed1985

Management of giant cystic hygromas in infants.

Giant cystic lymphangioma is a rare lesion that presents major therapeutic challenges. Four infants presented in the first weeks of life with diffuse cysts in the neck. The tongue was involved in three, the mediastinum in one, and the pharynx and supraglottic larynx in two. These lesions are characterized by hundreds of cysts that infiltrate in and around muscles, nerves, and vessels. Complete excision is not possible without damaging the normal structures. All four infants initially had partial removal with unroofing and drainage of the remaining cysts and temporary tracheostomy to protect the airway. One infant died from a thrombosed sagittal sinus. She had severe venous congestion of the head and neck postoperatively which may have been caused by an overzealous attempt to remove all of the cysts. The other three have required nine additional operations for removal of recurrent neck cysts (one operation), removal of mediastinal cysts (one operation), partial glossectomy (three operations), and laser excision of lymphangiomas of the pharynx and supraglottic larynx (four operations). Two patients have required partial glossectomy which should be performed early to protect the airway, to allow normal speech development, and to prevent malocclusion and prognathism from constant pressure of the tongue against the teeth. Removal of wedges of tissue from each side and from the center of the dorsum of the tongue reduces bulk with minimal risk to the lingual arteries and nerves. Recurrent tongue enlargement is common and can be treated by repeated partial glossectomy. Lymphangiomatosis of the pharynx and supraglottic larynx is difficult to treat. The carbon dioxide laser allows very precise excision of individual cysts with minimal drainage to adjacent mucosa, but in our limited experience it has not prevented recurrence. Despite the extensive nature of these lesions, the impossibility of complete excision, and the need for multiple operations, the long-term results in the three surviving patients have been satisfactory. Asymmetry of the neck and face due to lymphedema tends to improve with time. All three children have an acceptable appearance and normal speech for their ages.

Female↗

PubMed1985

Burn wound excision and local flap closure.

Eleven circumscribed, full-thickness burns were treated in 9 patients with immediate excision and primary closure of the defect or by using a variety of local random cutaneous and musculocutaneous flaps. The burns were located on the face, trunk, and extremities. In 2 patients this technique was used in the management of smaller burns on one surface of the body, thus facilitating skin grafting of larger wounds on the opposite surface. The cutaneous flaps utilized included advancement flaps, V-Y flaps, Moberg flaps, and S-plasties. The timing of the excision and closure varied from 2 hours to 2 weeks following thermal injury, with no postoperative wound infections. In selected cases primary excision of deep burns and closure by use of local tissue approach ideal treatment. With certainty of the depth of destruction, this procedure should be carried out regardless of locality when technically and anatomically feasible.

Adolescent↗

PubMed1985

Management of recalcitrant bronchopleural fistulas with muscle flap obliteration.

Use of muscle flap obliteration for bronchopleural fistulas appears to be indicated with (1) failure of a previous thoracoplasty, (2) anticipated failure of a thoracoplasty alone, and (3) the need to obviate a formal debilitating thoracoplasty. With the use of well-vascularized muscle flaps to fully obliterate the densely scarred cavities associated with persistent bronchopleural fistulas, we may hope to see improved healing in the bronchial stump and, in cases of residual infection, better resistance of the flap to necrosis, as well as improved delivery of chemotherapeutic agents to the local tissues. These factors may confer improved cure rates for bronchopleural fistulas similar to those seen in lower extremity salvage surgery for osteomyelitis following the introduction of vascularized pedicle and free muscle flaps. In this article we have described the versatility of the island pedicle latissimus dorsi muscle flap for closure of recalcitrant bronchopleural fistulas and associated empyema cavities. Utilizing either the dominant thoracodorsal or the minor paraspinal pedicle(s), it can reach any intrathoracic cavity by means of the appropriate thoracotomy incision.

Aged↗

PubMed1985

Versatility and safety of flap coverage for wide excision of cutaneous melanomas.

This study is a retrospective analysis of a consecutive series of 85 patients with primary melanomas of the trunk (51 patients) and extremities (34 patients) treated by wide excision and flap repair. Both the standard rhombic flap (39 cases) and the double-Z rhomboid flap (46 cases) were used. Postoperative follow-up was 11 to 49 months, with a mean of 20 months. Major postoperative flap necrosis was encountered in one case (1.1 percent). There were no local recurrences and only one instance of intransit metastasis. As compared with skin grafts, flap repairs were found to be free of the classic contour defect. In this series, flap repair also permitted earlier mobilization and resulted in shorter hospital stays.

Humans↗

PubMed1985

Pectoralis major myocutaneous reconstruction of the anterior skull base.

It was once believed that prognosis for many patients with neoplasms of the anterior skull base was hopeless. Now, however, craniofacial resection of these lesions has been curative for many patients. Massive resections of the anterior skull base pose many potentially life-threatening complications. Cerebrospinal fluid leakage with meningitis is especially troublesome when previous radiation therapy compromises wound healing. In such circumstances local tissue flaps and skin grafting may not provide reliable separation of the brain from the nose. The pectoralis major flap was utilized in eight patients undergoing anterolateral resection of the skull base. Several major advantages of this technique include: 1. reliable closure of the subarachnoid space; 2. acceptable cosmesis; 3. rapid wound rehabilitation, allowing early postoperative radiation therapy when necessary.

Adenocarcinoma↗

PubMed1985

Hippocrates, the true father of hand surgery.

The methods used by Hippocrates for treating fractures and dislocations formed the basis for further development in operations performed upon the hand. He described the common distal radial fracture, and the method to reduce and immobilize it. Of carpal dislocations, he mentioned two patterns which are similar to the common "anterior dislocation of the lunate" and the "perilunar dislocation." He treated pressure sores and wound infection with frequent dressings, application of heat and mechanical debridement; limb necrosis was treated with delayed amputation, and tetanus, with immediate exploration and drainage of the wound. His general principles of fracture management include the value of early reduction, strict fluid diet after reductions of large joints, keeping sites of fracture warm and changing splints as the swelling resolves. It is obvious that many of the principles for the treatment of fractures and dislocations of the wrist and hand are still valid today. The genius of Hippocrates surpassed all those whom we know at a corresponding stage of civilization and for many years to come. The discovery of roentgenograms an antiseptics only furthered his established sound principles. On the basis of these principles, perhaps Hippocrates should be considered the true father of operations performed upon the hand.

Fractures, Open↗

PubMed1985

Prophylactic mastectomy for precancerous and high-risk lesions of the breast.

The candidates for prophylactic mastectomy are those who have a family history of breast cancer, multiple fibrocystic masses that have been biopsied or are too numerous to biopsy appropriately, or patients who previously have had cancer in one breast. The decision to perform the subcutaneous mastectomy is one that must be made by the surgeons involved, in consultation with the patient and her husband. The data from subcutaneous mastectomies appear promising and the technical results have improved as experience has been gained. However, 5 to 10 more years are necessary to determine whether this procedure decreases the incidence of breast cancer in these high-risk patients.

Adult↗

PubMed1984

Management of sclerodermal finger ulcers.

Ninety-three percent of 59 patients with scleroderma reviewed in this study presented with Raynaud's phenomenon at a mean age of 43 years; 65% of these developed fingertip ulcers within 4 years. Other common findings were sclerodactyly, distal phalangeal resorption, calcinosis cutis, and digital contractures. Medical management of the digital ulcers with systemic and regional vasodilating drugs was unsatisfactory. Sympathectomy, when performed early, temporarily relieved vasospastic pain but did not affect the course of the ulcers. Severe digital pain was the most incapacitating symptom resulting from vasospasm early in the course of the disease and irreversible arterial luminal narrowing later in the course. Conservative fingertip amputations for nonhealing ulcers constituted the management of choice to eradicate the ulcer, to reduce or eliminate the pain, and to return the hand to early useful function. A decision tree for the management of these ulcers is proposed.

Adolescent↗

PubMed1984

An experimental model to determine the level of antibiotics in irradiated tissues.

An experimental study was designed using male Sprague-Dawley rats treated with a single dose of 1800 rads to an area of skin and soft tissue of the back measuring 2 X 3 cm. This dose was estimated to produce changes equivalent to 6000 rads in divided doses over 6 weeks. At intervals of 5, 10, and 15 weeks after irradiation, punch biopsies were taken from both irradiation, and nonirradiated skin areas of each animal 30 minutes after the intraperitoneal administration of gentamicin. Skin homogenates were prepared, and the antibiotic levels in these samples were determined by a bacterial growth inhibition assay. The antibiotic levels were found to be equal (16.1 +/- 6 micrograms/ml vs. 16.0 +/- 5 micrograms/ml) in both irradiated and nonirradiated skin at 5 weeks after radiation. However, at 10 and 15 weeks after radiation, the antibiotic levels had dropped to 9.9 +/- 3 micrograms/ml in irradiated skin compared with 14.1 +/- 4 micrograms/ml in normal skin (p less than 0.001) and with 5.4 micrograms/ml in irradiated skin vs. 11.8 +/- 5 micrograms/ml in nonirradiated skin (p less than 0.001), respectively. Results demonstrate that in spite of adequate gentamicin levels in the circulation and nonirradiated tissue in rats, gentamicin has a decreasing ability to diffuse into irradiated tissues with increasing intervals after therapeutic doses of radiation.

Animals↗

PubMed1984

Reversal of postburn immunosuppression by the administration of vitamin A.

The effect of high doses of vitamin A was evaluated on the suppression of cellular immunity after a 30% body surface area experimental scald burn in a mouse model. Male CBA/J mice were treated postburn with daily intraperitoneal injections of either 3000 IU of vitamin A or an equal volume of 0.9N saline. Similar groups of unburned mice were also studied as controls. At the seventh postburn day, one-way mixed lymphocyte reactions were tested for each group with whole spleen cells of CBA/J mice used as responders and mitomycin C-treated whole spleen cells of C57 BL/6 mice used as stimulators. When results were expressed as mean percentage of the values of control animals, no significant difference was observed between the saline-injected unburned control group (taken as 100%) and the vitamin A-treated unburned control groups (89%). The burned animals treated with saline showed suppression to 21% of the control values. However, the burned animals treated postburn with vitamin A improved the response rate dramatically to 52% of control values. This improvement over the untreated burned animals was significant in all experiments performed (p less than 0.02). This study suggests that vitamin A may be an effective agent in the reversal of cellular immunosuppression after burns.

Animals↗

PubMed1984

Regional isolated perfusion of high risk melanoma of the extremities with imidazole carboxamide.

Twenty-four patients have been treated by regional isolated perfusion with decarbazine for melanoma of an extremity, with a follow-up period of seven to 72 months. None of these patients had any signs or symptoms of toxicity from the drug. The serum glutamic-oxalacetic transaminase level was elevated by the first postoperative day and returned to normal within the next six days. Fourteen of these 24 patients are free of disease for a follow-up period of 23 to 70 months. Three of the seven patients treated for local or intransit metastases are free of disease for five, 60 and 61 months; a fourth patient had subcutaneous metastases of the trunk develop while remaining disease-free in the perfused extremity for 72 months, and a fifth patient perfused for numerous intransit metastases of a leg had resolution of many of the nodules and remains without new lesions for nine months. Decarbazine is recommended as a safe and valuable drug for the perfusion of extremities with melanoma.

Arm↗

PubMed1983

Myocutaneous flaps for challenging problems in head and neck reconstruction.

We treated three cases of recurrent head and neck carcinoma viewed as challenging reconstructive problems because of the extent of the extirpative surgery necessary and the substantial risk of complications that would be associated with previous treatment techniques. In each case, the versatility of myocutaneous flaps is illustrated. In case 1, a double-paddle pectoralis major flap was employed. In case 2, with an exposed infected carotid artery and a failed pectoralis major flap, reconstruction was accomplished by using an ipsilateral trapezius myocutaneous flap. In case 3, for reconstruction of the pharynx with a low esophagostoma, a double-paddle pectoralis major and split-thickness skin graft were used.

Arteries↗

PubMed1983

Extensor indicis brevis: a rare anatomical variation.

We describe a rare anatomical variant, the extensor indicis brevis--a "short" index extensor originating from the ligament over the scaphoid bone. In our patient it presented as a tender mass. The knowledge of such anatomical variations is important in diagnosing dorsal hand masses and in planning tendon transfers.

Adolescent↗

PubMed1983

Tomographic gallium-67 citrate scanning. Useful new surveillance for metastatic melanoma.

Conventional gallium scans are not useful to evaluate patients with metastatic melanoma. We evaluated a new method of tomographic gallium imaging. One hundred fourteen tomographic scans were obtained in a prospective surveillance study of 67 patients over a 3-year period. Scans were evaluated and compared to findings of independent clinical evaluations. Sensitivity of gallium identification of tumor involving peripheral lymph nodes and soft tissues, abdomen, mediastinum, and osseous sites was 68% to 100%; overall sensitivity of this technique is 82% with specificity of 99% in 570 organ system assessments. Analysis of discordant findings when a site was clinically occult but gallium-positive showed gallium uptake to be true-positive in six of seven lymphatic sites, three of three lung and mediastinal sites, six of six abdominal sites, but in no brain or bone sites. Gallium lesions identified by computed tomographic scans proved to be false-positive at one lymphatic and one bone site, and false-negative at four otherwise clinically evident lymph node and soft tissue sites, seven pulmonary sites, and four brain sites. Gallium tomographic scanning provides a composite assessment of melanoma and may eliminate the need for other studies.

Adult↗

PubMed1983

The pectoralis major for single-stage reconstruction of the difficult wounds of the orbit and pharyngoesophagus.

This paper reports the results of reconstructions of difficult wounds in the head and neck area with musculocutaneous flaps in 20 patients. Twelve patients had reconstructions following cranial and orbital resections, and eight patients had reconstructions of the pharyngoesophagus. There were four wound complications, all of which healed without further surgical procedures. The pectoralis major musculocutaneous flap continues to be the most versatile flap for reconstructions at a variety of sites in the head and neck area. Contrary to other reports, it has not been bulky, it has been used without previous delays of the skin paddle, it has not required skin grafts to close the donor sites, and it has been used without difficulty in five female patients.

Adult↗

PubMed1983

Repair of lumbosacral myelomeningoceles with double Z-rhomboid flaps. Technical note.

The authors describe a double Z-rhomboid technique for the closure of large lumbosacral myelomeningocele defects. After the dorsally displaced neural tissue has been reduced into the vertebral canal and a watertight closure of the dura lining the sac has been achieved, the skin defect is surgically converted to the shape of a rhombus. Equilateral Z-plasty flaps are elevated at the sides of the rhombus and transposed across the defect to secure wound closure. A successful experience with 10 consecutive cases of lumbosacral myelomeningoceles repaired with this technique is reported.

Humans↗

PubMed1983

Necrotizing sialometaplasia: report of five cases.

The natural history of necrotizing sialometaplasia as a self-healing process makes it essential for the surgeon and the pathologist to distinguish this entity from carcinoma. Seventeen of the 39 early cases were initially misdiagnosed as malignant. Occasionally, residual glands can be trapped in mucous lakes, giving the appearance of mucoepidermoid carcinoma. An awareness of the entity and adequate clinicopathologic correlation should lead to a correct diagnosis. A limited biopsy specimen may create a problem in diagnosis and may necessitate more adequate tissue for proper evaluation. Necrotizing sialometaplasia can present as an ulceration or a swelling beneath the mucosa, either of which can be painless or painful with radiation of pain to the ear, eye, or pharynx. Lesions presenting as a swelling will either convert to an ulceration or heal spontaneously, never forming an ulcer. The most commonly involved area is the palate (79 percent), but any area where glandular oral mucosa is present can be involved. The male-to-female ratio is 3:1, and it shows no predilection for race. The etiology of the disease remains unknown, but it may be associated with tobacco, alcohol, the use of dentures, and local trauma. Most investigators seem to favor an ischemic basis. Lesions heal spontaneously without treatment, and the only invasive procedure required is a biopsy.

Adult↗