Rapid diagnosis of indwelling pulmonary artery catheter-induced ventricular arrhythmias by the characteristic left bundle branch block morphology and inferior frontal plane axis.
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Adult↗
Biomedical subjects
T D Wang
Publications and source records attributed to T D Wang.
Unilateral pulmonary artery agenesis in adulthood. Not always a benign disease.
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Adolescent↗
The liposhaver in facial plastic surgery. A multi-institutional experience.
OBJECTIVE: To report a multi-institutional clinical experience with the liposhaver in facial plastic surgery. DESIGN: Nonrandomized, nonblinded, multi-institutional evaluation of the liposhaver in a clinical setting in patients presenting for cosmetic facial liposuction. INTERVENTIONS: Cosmetic facial surgery with the liposhaver was performed in 19 patients (21 procedures) who underwent submental lipectomy, facelift with defatting beneath the facelift flap, and/or correction of deep nasolabial folds. Standardized preoperative and postoperative photographs were obtained. Fat obtained from the abdomen of 1 patient was also studied histologically. This fat was excised sharply and was then liposhaved at varying oscillation speeds. OUTCOME MEASURES: Subjective evaluation by the operating surgeons. RESULTS: The liposhaver was used successfully in all cases. The fat was cleanly shaved and the contour results were even, without dimpling or asymmetry. Operative time was comparable to that for conventional liposuction. Preferred cannula sizes and settings were determined. There were no cases of facial nerve injury, no evidence of increased bleeding intraoperatively, and no hematomas in the immediate postoperative period. One patient developed a small hematoma on postoperative day 5 that was effectively treated with needle aspiration and a pressure dressing. Histologic evaluation of liposhaved abdominal fat showed normal fat cells and well-preserved architecture. CONCLUSIONS: The liposhaver offers a precise alterative to conventional liposuction. It may be less traumatic because it requires low suction pressures and does not rely on the potentially bruising, vigorous, back-and-forth motion for fat extraction typical of conventional liposuction.
Adipose Tissue↗
Multiple periorbital cutaneous myxomas progressing to scleromyxedema.
Myxomas are rare cutaneous tumors that have been associated with a variety of other abnormalities including atrial myxomas, endocrine abnormalities, and bone malformations. We describe a 38-year-old white man with multiple periorbital myxomas in whom myalgias, fatigue, and more diffuse cutaneous involvement developed. These findings were consistent with scleromyxedema. He also had an associated left subclavian deep venous thrombosis. The patient responded well to therapy with cyclophosphamide.
Adult↗
Fluorescence endoscopic imaging of human colonic adenomas.
BACKGROUND & AIMS: Endoscopic screening for sporadic colorectal cancer relies in part on the detection of adenomatous polyps. Nonpolypoid adenomas or flat dysplasia may go unrecognized by conventional endoscopy. This study attempted to develop and test a novel endoscopic method for detecting polypoid and nonpolypoid colonic adenomas. METHODS: Colectomy specimens from 3 patients with familial adenomatous polyposis containing polypoid and nonpolypoid adenomas were illuminated with excitation light at 351 and 364 nm. Endoscopic images of the net tissue fluorescence emitted were collected over the spectral bandwidth from 400 to 700 nm. Each raw image was corrected for differences in distance and instrument light collection efficiency by normalizing to a spatially averaged image. Intensity thresholding was then used to identity regions of diseased mucosa. RESULTS: The average fluorescence intensity from normal mucosa was found to be greater than that from adenomas by a factor of 2.2 +/- 0.6. The sensitivity and specificity for detecting a region of dysplasia varied with the threshold value selected. At a threshold of 75% of the average normal intensity, a sensitivity of 90% and a specificity of 92% were achieved. CONCLUSIONS: Fluorescence images of colonic mucosa can be collected endoscopically, and dysplasia can be detected and localized with high sensitivity and specificity. These results show the potential of this technique to direct endoscopic biopsy.
Adenoma↗
Rejuvenation of the aging forehead and brow.
Rejuvenation of the aging upper face can transform tired and angry features into youthful-appearing ones. This article presents the principles for analyzing and treating the aging forehead and brow. The esthetic dimensions and proportions of the brow and forehead are discussed, in context with the corresponding surgical anatomy. The goals of facial rejuvenation surgery as it relates to the upper third of the face are addressed. Various approaches, including their advantages and disadvantages, are presented. The appropriate approach is selected to eliminate unsightly features that are in need of correction while minimizing hairline shifts and forehead scarring and anesthesia. Following the principles and techniques illustrated in this article, the facial plastic surgeon may confidently treat the signs and complaints of the aging upper face.
Aged↗
Rapid hepatic failure associated with a contracted liver mimicking cirrhosis in a case of nasopharyngeal carcinoma with liver metastasis.
A 46-year-old women had an undifferentiated nonkeratinizing nasopharyngeal carcinoma, locally controlled by radiotherapy. Initially, she had normal liver function tests and normal hepatic ultrasonography. Seven months later, she experienced a rapidly progressive hepatic failure manifested by the development of ascites, elevation of serum bilirubin level, and prolongation of prothrombin time. Imaging studies showed a contracted liver and serum biochemical tests were compatible with chronic liver disease, except for an increase of alkaline phosphatase and gamma-glutamyl transpeptidase levels. An endoscopic retrograde cholangiogram ws compatible with changes of sclerosing cholangitis. The patient died of hepatic decompensation within two months. A liver necropsy disclosed diffuse infiltration of carcinoma cells into the hepatic sinusoids and obliterative angio-invasion of the tumor cells with massive fibrotic stroma replacing almost all hepatocytes. In situ hybridization demonstrated expression of Epstein-Barr virus transcripts EBER1 in the tumor cells and proved a metastatic nasopharyngeal carcinoma. The contracted liver is likely to be explained by the tumor-associated desmoplastic change and the obliterative angio-invasion of the tumor. It is important to be aware that, although rare, such an unusual pattern of liver metastasis may mimick cirrhosis clinically and cause rapid hepatic failure in patients with nasopharyngeal carcinoma.
DNA Probes↗
Recurrent vertebral osteomyelitis and psoas abscess caused by Streptococcus constellatus and Fusobacterium nucleatum in a patient with atrial septal defect and an occult dental infection.
We describe a case in which recurrent vertebral osteomyelitis and psoas abscess due to Streptococcus constellatus and Fusobacterium nucleatum developed in a patient with a previously unrecognized atrial septal defect with bidirectional shunts. Disease recurrence was ascribed to the presence of dental disease, which served as the source of infection. To the best of our knowledge, this is the first case in which vertebral osteomyelitis and psoas abscess have been associated with atrial septal defect.
Focal Infection, Dental↗
Infected left atrial myxoma caused by Gemella morbillorum.
Gemella morbillorum was isolated from the blood of a 38-year-old woman with a 4-week history of fever. An echocardiogram showed a left atrial tumor. The patient was successfully treated by antibiotic therapy and early surgical excision of the tumor. Histological examination of the excised tumor revealed a typical myxoma with infiltrates of neutrophils and remnants of bacteria. To the best of our knowledge, this is the first reported case of infected left atrial myxoma caused by G. morbillorum.
Adult↗
The epithelial 'turn-in' flap in nasal reconstruction.
OBJECTIVES: To evaluate the epithelial "turn-in" flap for reconstruction of the internal lining in full-thickness nasal defects. Highlighted are its indications, technique, complications, and clinical success, particularly in comparison with the other common modalities for reconstructing this nasal lining. Also, to determine how the random flap withstands vigorous thinning. DESIGN: A retrospective chart review and clinical follow-up of all patients with full-thickness nasal defects of the nose. SETTING: The patient pool comes from a tertiary care center that draws from a large geographic area in the Northwest. Both urban and rural demographics are represented. PATIENTS: Fifty-six patients with large full-thickness nasal defects were reviewed, 18 of which were reconstructed with the epithelial turn-in flap. The causes of the original defect were varied. INTERVENTION: Full-thickness nasal defects were reconstructed in a layered fashion. The turn-in flaps were aggressively thinned to the subdermal plane to minimize flap bulk and airway compromise. MAIN OUTCOME MEASURES: Attention was made to the size and precise location of the defect, the mode of reconstruction, flap viability, and nasal function. RESULTS: Eighteen patients had turn-in flaps for reconstruction of the internal lining. Sixteen patients (89%) had 100% viability of their flaps. Seventeen (94%) reported normal nasal function. CONCLUSIONS: The epithelial turn-in flap is a robust flap that provides dependable and functional results. One of the major advantages of this flap over other methods is that often there is no donor site morbidity. For many select defects, the turn-in flap remains a method of choice for repair of the internal lining.
Adolescent↗
Temporoparietal fascial flap in auricular reconstruction.
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Aged↗
Dura mater for soft-tissue augmentation. Evaluation in a rabbit model.
Irradiated human dura mater, a commercially available preparation of dura mater (Tutoplast), and irradiated rabbit dura mater were implanted in subcutaneous pockets in the pinna and forehead of New Zealand white rabbits and evaluated for their usefulness in soft-tissue augmentation at 3 months and 6 months. Postoperatively, no evidence of erythema, purulence, hematoma or seroma formation, wound dehiscence, graft extrusion, or flap necrosis was noted. Irradiated human dura mater was well tolerated by the host and elicited a mild cellular inflammatory response. The graft was well preserved, infiltrated by fibrous connective tissue, and fixed in place in the pinna sites. Forehead grafts were surrounded by a capsule of host tissue and were intact. Dura mater seems to be useful for soft-tissue augmentation. Tutoplast may give good results clinically. Because this represents a short-term evaluation, long-term clinical results are needed to define the potential of dura mater grafts.
Animals↗
The effect of tissue expansion on the random flap viability and wound tensile strength of previously irradiated rabbit skin.
Tissue expansion facilitates coverage of cutaneous defects both through the generation of additional skin surface area and by increasing random flap length/width viability factors. The opportunity to apply tissue expansion techniques to head and neck defects within previously irradiated skin fields continues to increase. To study the effect of tissue expansion on the cutaneous perfusion and wound-healing capacity of irradiation-damaged skin, rabbit scalps were subjected to 5 weeks of fractionated radiation followed at 4 months by prolonged tissue expansion. Standardized random flaps were then created and reset within the expanded skin and analyzed in parallel with nonirradiated and nonexpanded control animals. Flap viability as expressed by area and mean maximum length was determined at 10 days postwounding followed by determination of wound-breaking strength. Irradiated tissues demonstrated a significantly reduced flap viability that was significantly increased by expansion. However, tissue expansion-related increases in flap length exceeded those expressed as percent of total area surviving for irradiated animals. Tissue expansion resulted in significant increases in wound tensile strength only in nonirradiated animals. These findings suggest that, compared with controls, several of the benefits of tissue expansion are less appreciable in radiation-damaged skin.
Analysis of Variance↗
[Synthesis and antitumor activity of 4-O-(halogenated) acyl-4'-demethylepipodophyllotoxin analogues].
A series of 4-(halogenated)acyl-4'-demethylepipodophyllotoxin analogues were conveniently synthesized by selective esterification in the presence of BF3.Et2O, and screened in vitro against L1210 leukemia and KB cells. Most of these compounds showed marked antitumor activity and exhibited more potent activity than that of etoposide.
Animals↗
[Synthesis and antitumor activity of 4-S-(5-amido-1,3,4-thiodiazol-2-yl)4-deoxy-4'-demethylepipodophyllotoxi n analogues].
By the condensation of 4'-demethylepipodophyllotoxin with 2-amino-5-mercapto-1,3,4-thiodiazole in CF3COOH and acylation in the presence of DEPC, 10 title compounds were conveniently synthesized. These compounds were screened in vitro against L1210 leukemia and KB cells, in which compounds SIPI-92-1772, 1774, 1775, 1776, 1777 and 1779 exhibited more potent anti-tumor activity.
Animals↗
[Synthesis and antitumor activity of 4-(2-amido-2-ethoxycarbonyl) ethylsulfenyl-4-deoxy-4'-demethylepipodophyllotoxin analogues].
Twenty three 4-(2-amido-2-ethoxycarbonyl) ethylsulfenyl-4-deoxy-4'-demethylepipodophyllotoxin analogues were synthesized by three steps, in which trifluoroacetic acid was used as a condensation agent of 4'-demethylepipodophyllotoxin with L-cysteine ethyl ester hydrochloride without any protection of phenolic hydroxy and amino groups. All compounds were screened in vitro against L1210 leukemia and KB cells, in which, compounds 11, 16 and 18 exhibited more potent antitumor activity than etoposide.
Animals↗
The effect of tissue expansion on previously irradiated skin.
Opinion remains divided over the advisability of tissue expansion in previously irradiated skin. We examined the properties of, and complications associated with, tissue expansion in previously irradiated rabbit scalps. Irradiation injury was produced using fractionated roentgen rays, with a total dose of 5000 cGy over a 5-week interval. Following a 20-week convalescence interval, expansion was incrementally conducted over 4 weeks. Monitored parameters included cutaneous perfusion as indicated by fiberoptic dermofluorometry, intraluminal pressure, linear surface gain, and area of surface necrosis. The incidence and severity of complications, including surface necrosis, were significantly higher among irradiated animals. Furthermore, the overlying skin of irradiated animals demonstrated a significantly decreased compliance and measurable area gain. Given the inferior expansibility and higher tendency toward complications with contemporary expansion techniques in previously irradiated skin, alternate reconstructive options are preferable in this setting.
Animals↗
Cervical rotation flaps for midface resurfacing.
The midface has long served as a focus for creativity in surgical reconstruction. Full-thickness skin grafts, split-thickness grafts, and distal flaps have long been used to attempt to reduplicate existing anatomy in this area. Recent reconstruction efforts have focused on the creative use of microvascular free flaps for this purpose. This article reports on the use of extensively developed regional rotation flaps as an excellent reconstructive modality for use in this area of the face. The details of surgical incisional planning are given. The nuances of surgical creation of these flaps and their rotation and suspension into place are given. The cases we have done using this technique for the past 3 years are reviewed. Our present indications for use of these flaps and their limitations are given.
Adult↗