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Biomedical subjects

S Ariyan

Publications and source records attributed to S Ariyan.

At least 91 records · Page 5Linked to original sources
PubMed1982

Granulomatous lymphangitis. A complication of intralymphatic immunotherapy with methanol extraction residue of BCG (MER).

Patients with thick primary melanomas, (Stage I) or regional nodal spread (Stage II) are at substantial risk for recurrence following usual definitive surgical excision of the primary tumor with or without lymphadenectomy. Trials of nonspecific adjuvant agents such as bacille Calmette Guerin (BCG) in experimental animals and man suggest that antitumor effects are greatest when the agent is injected near tumor of limited mass. We report a new approach to adjuvant therapy using preoperative intralymphatic injections and intraoperative local instillations of the nonviable methanol extraction residue of bacille Calmette Guerin (MER). Thirteen individuals with thick primaries, regional metastases, or recurrent melanoma of the extremities have entered the experimental program. We report here one complication of this immunotherapy observed in four of 13 treated individuals, granulomatous lymphangitis. The clinical presentation, course, and treatment of this complication are described. Its potential relation to the success of this therapy is discussed.

Adult↗
PubMed1982

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↗
PubMed1982

Intralymphatic and regional surgical adjuvant immunotherapy in high-risk melanoma of the extremities.

A prospective, controlled study of surgical adjuvant immunotherapy with intralymphatic methanol-extractable residue (MER) of bacillus Calmette-Guerin (BCG) is preliminarily reported in 25 consecutive patients with high-risk malignant melanoma of the extremities. Patients were allocated on a random basis to receive preoperative intralymphatic immunotherapy with MER-BCG, surgical excision with regional lymphadenectomy and intraoperative infiltration of MER-BCG, and postoperative monthly intradermal vaccinations with BCG; or surgery and lymphadenectomy alone. Twenty patients followed for more than 1 year are the basis of this report. Fifteen patients accepted randomization, whereas four patients entered the immunotherapy group and one entered the control group at their own insistence. Immunotherapy improved the disease-free survival of patients in this trial. There was one recurrence with death in the 13 patients treated with preoperative intralymphatic MER-BCG; whereas four of seven patients in the control group had recurrence (P = 0.015), at all four of these patients died during the same interval.

Adjuvants, Immunologic↗
PubMed1981

Improved reliability in tumor diagnosis by fine needle aspiration.

A simple but useful modification of sample preparation of fine needle aspirates of soft tissue masses is presented, in conjunction with its assessment by a controlled study. The modification, employing routine histologic techniques, reduces the requirement for cytopathologic expertise. The potential utility of fine needle aspiration is thereby significantly expanded. In addition, this modification allows the pathologist to use special tissue strains or electron microscopy as options, when necessary, to enhance diagnostic accuracy.

Adult↗
PubMed1980

Musculocutaneous flaps in head and neck reconstruction.

The development of the new myocutaneous flaps in recent years has ushered in an era of early reconstructions with one-stage repairs. The availability and reliability of these flaps make them appealing for use at a variety of sites. The experience gained from the use of these new flaps has confirmed their safety and versatility even within radiated fields. Since these flaps permit reconstruction in one stage, patients face less disability and their hospital stays are shortened.

Head and Neck Neoplasms↗
PubMed1980

Reduction mammaplasty with the nipple-areola carried on a single, narrow inferior pedicle.

Transposition of the nipple-areola on a narrow, single, inferiorly based breast subcutaneous pedicle in reduction mammaplasty is safe, even in patients with massive macromastia. We report breast reduction performed with the single pedicle in 15 breasts in 10 patients, with bipedicles as long as 51 cm (prior to amputation), with single inferior pedicles as long as 30 cm, and with resections of up to 3,000 gm per breast. We are not proposing resection of the superior pedicle in all vertical pedicle mammaplasties; we are saying, rather, that the superior pedicle may be discarded with the resected breast tissue, and the nipple-areola may be transferred safely on a pedicle that is narrower than previously described by others.

Breast↗
PubMed1980

The viability of rib grafts transplanted with the periosteal blood supply.

We present two additional cases of microvascular rib transplants supplied by the periosteal circulation through the anterior intercostal vessels. We studied the viability of the bone by the uptake of fluorochrome markers. We also examined thin sections of calcified bone to demonstrate the deposition of new osteoid by osteoblasts, and the resorption of bone by osteoclasts. These studies confirm the early viability of the transplanted bone.

Cell Survival↗
PubMed1980

An experimental model to determine the effects of adjuvant therapy on the incidence of postoperative wound infection: I. Evaluating preoperative radiation therapy.

This study investigated the effects of local preoperative radiation on the tissue resistance to surgical infection. Preoperative radiation was given to the skin of the backs of 144 rats in two doses and wounded at intervals after the radiation. As determined by quantitative bacterial counts of the wounds 4 days after wounding, 80 to 100 percent of the rats in each group healed their wounds with counts that were 10(3) organisms per gram, or less, in spite of the dose of radiation or the interval to wounding. In an additional 560 rats, 10(4) S. aureus organisms were inoculated into the surgical wounds made at various intervals after three doses of radiation. In this part of the study, the rates of infection (as determined by bacterial counts of 10(5) per gram or more) increased significantly with the increasing dose of radiation, as well as with the increasing interval from radiation to wounding. These data demonstrate that radiated tissue cannot tolerate bacterial contamination as well as normal tissue. Since surgery in the head and neck area results in the contamination of the wounds with saliva rich in virulent organisms, we propose that preoperative radiation be discontinued in favor of postoperative radiation.

Animals↗
PubMed1980

An experimental model to determine the effects of adjuvant therapy on the incidence of postoperative wound infection: II. Evaluating preoperative chemotherapy.

A study was performed in 110 rats to investigate the effect of an LD50 dose of MTX, rescued with leucovorin treatment in 24 hours, on the ability of surgical wounds to tolerate bacterial contamination. The results of this study would indicate that the optimal time to ensure normal wound healing would be an interval of 10 to 14 days following the administration of large doses of this drug. This information would suggest that the use of methotrexate as a preoperative adjuvant, and radiation therapy following the surgical removal of the tumor, might be a reasonable approach to the adjuvant treatment of head and neck cancer without increasing the risk of wound infections.

Animals↗
PubMed1980

Immediate reconstruction of a composite mandibular defect with a regional osteomusculocutaneous flap.

This is a report of an immediate reconstruction of a composite mandibular defect, using a pectoralis major osteomusculocutaneous flap incorporating a segment of the fifth rib. Viability of the transferred rib segment was established by tetracycline labeling at 2 weeks and technetium scanning at 3 months postoperatively. This clinical example supports the experimental observations of a vascular network interconnecting muscle, periosteum, and compact bone.

Bone Transplantation↗
PubMed1980

Functional radical neck dissection.

A technique is described for performing a radical neck dissection by elevating the muscle out of the neck to facilitate the complete removal of all the neck structures without injury to the muscle and without significantly increasing the operative time. The neck dissection can be performed as a "classical" radical neck dissection by removing all the neck structures en bloc, including the jugular vein and spinal accessory nerve. Alternatively, a "functional" radical neck dissection can be done in selected cases by dissecting out and preserving the jugular vein and/or the spinal accessory nerve. The sternal end of the sternocleidomastoid muscle is then reattached before closing the neck wounds. This technique was used unilaterally in 11 patients and bilaterally in 2 patients, without complications. The cosmetic results demonstrate a significant advantage of this method over the routine classical radical neck dissection. The results in this small series, with follow-up periods of 18 to 40 months in patients with squamous cell carcinoma, suggest that this procedure gives good results in selected cases.

Accessory Nerve↗
PubMed1980

The sternocleidomastoid myocutaneous flap.

The sternocleidomastoid muscle has three blood supplies: the occipital artery superiorly, the superior thyroid in the middle, and the thyrocervical trunk inferiorly. A compound flap has been developed to transport segments of neck skin on either end of a pedicle of sternocleidomastoid muscle to reconstruct defects in the oral cavity or orophaynx. It permits one-stage reconstruction at the time of the primary resection and eliminates the need for skin grafts to the donor sites.

Head and Neck Neoplasms↗
PubMed1980

Pectoralis major, sternomastoid, and other musculocutaneous flaps for head and neck reconstruction.

The development of the new myocutaneous flaps has ushered in an era of one-stage reconstructions that have already changed the patterns of surgery for head and neck cancer. The availability, the technical ease of the surgical procedures, and the reliability of these compound flaps make them very attractive for widespread use for reconstructions at a variety of sites. The experience gained from the use of these new flaps has confirmed their safety and versatility. They have decreased the disability and shortened the hospital stay for these patients.

Carotid Arteries↗
PubMed1979

One-stage repair of a cervical esophagostome with two myocutaneous flaps from the neck and shoulder.

A large esophagostome in a heavily radiated neck was reconstructed in one stage, using a sternocleidomastoid myocutaneous flap for lining and a trapezius myocutaneous flap for covering. The patient began eating on the seventh day and was discharged on the tenth day following the repair. Barium swallow studies demonstrated a widely patent esophagus, and the patient now has good esophageal speech.

Adult↗