Biomedical subjects
Publications and source records attributed to V L Lewis.
A patient with a persistent trigeminal artery and occlusion of the internal carotid artery is presented. The development and protective hemodynamic significance of this persistent embryological anastomosis are briefly discussed.
Osteosclerosis of the bone ends is an unusual manifestation of renal osteodystrophy. In evaluating this finding one should be careful to exclude clinical and radiographic evidence for osteonecrosis. In the two known cases of this entity, bone end sclerosis has been found to develop over one to two years with symmetrical involvement of multiple bones.
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There are few reports on extensive suprapubic vesicocutaneous fistulas. We report the problems encountered in the closure of these fistulas following lower abdominal trauma. Two patients are described in whom the trauma produced extensive loss of skin, fascia and muscle, leaving the bladder exposed and open. Despite several attempts at bladder closure the bladder repair always failed and the fistula remained open. It was necessary to cover the subsequent bladder closure with overlying muscle, fascia and skin to obtain a successful closure. The techniques of closure are explained.
The design of the tensor fascia lata myocutaneous flap can be modified, allowing its use as a V-Y retroposition flap for treatment of trochanteric pressure ulcers. This technique eliminates the rotation point, puts the thickest portion of the flap over the defect, and obviates the need for skin grafts. It has been successfully employed to treat 11 trochanteric pressure ulcers in 10 patients in the past two years.
Sixty percent of the fibroblast strains derived from normal skin, scar, and keloid reached elevated growth plateaus when cultured in the presence of histamine. A pharmacologic level of the antihistamine diphenhydramine hydrochloride was able to suppress the stimulation in all the keloid strains that were histamine-sensitive.
Malignant degeneration of sebaceous and other epidermoid cysts in uncommon, but it does occur in approximately 2.2% of cysts examined. It should be suspected in patients with atypical appearance or a history of cyst recurrence. All cysts should be examined histologically and the histological grade carefully noted. This paper reports a well-differentiated squamous cell carcinoma arising in an epidermoid cyst. Wide excision was performed, including superficial parotidectomy, because of histological evidence of extension beyond the cyst. Based on the literature, recurrence or metastasis of our patient's tumor appears unlikely.
A large, nondelayed thoracoepigastric flap extending 6 cm beyond the posterior axillary line was used to cover an extensive electrical injury of the right upper extremity.
The second reported patient with simultaneous metastatic epidermoid carcinoma and chronic myelogenous leukemia is described. The difficulty of differentiating the leukemia from a leukemoid reaction is discussed. The incidence of, and importance of looking for, second primary cancers in patients known to have cancer is emphasized.
A rapid non-invasive test for the presence of B. melaninogenicus in the wounds of crepitant non-clostridial gangrene is described. The wounds are viewed under an ultraviolet light, and the presence of bright red fluorescene indicates the probable presence of B. melaninogenicus.
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The four patients presented here demonstrate the value of contrast enhanced CT in the diagnosis and serial evaluation of dural sinus thrombosis. Two patients were young women using oral contraceptives; another patient had lateral sinus thrombosis complicating mastoiditis; a fourth patient developed superior sagittal sinus thrombosis following hip surgery. Improvements in CT diagnosis, including the use of thin sections for evaluation of the deep venous structures and lateral sinuses complemented by multiplanar reconstruction or direct coronal scanning, are discussed. Sequential scans for following the progress of two patients treated by barbiturate coma added to the understanding of dural sinus occlusive disease.