Biomedical subjects
Publications and source records attributed to A M Guba.
A 35-year-old woman had a 4-year history of skin depression on the right side of both the forehead and chin. A biopsy specimen showed a normal dermis and an absence of subcutaneous tissue. She also had Poland syndrome on the left side of the body, with loss of the sternocostal portion of the greater pectoral muscle. Significant cosmetic improvement was achieved with dermal fat grafts and silicone implants.
Forty axial-pattern skin flaps in 10 pigs were studied, and 50 and 15 mu radioactively tagged microspheres were used to study blood flow at 2 days and 7 days after surgical delay. Blood flow increased during this period. No statistically significant change in the index of non-nutrient flow, an expression of arteriovenous shunting, or in percent shunting occurred. It would appear that changes in shunting during the period of delay studied did not occur and cannot explain the enhanced survival of tissue resulting from a surgical delay procedure.
When a vascular conduit becomes exposed, it is generally thought that if it is not already infected, it will soon become so. The most comprehensive treatment would be removal of the prosthesis, debridement of the wound, and extraanatomic bypass. Occasionally, however, extraanatomic bypass cannot be done. In such cases, local measures, such as skin grafting or skin flap coverage, may be used. Our two cases illustrate that these procedures can, on occasion, provide long-term coverage of exposed vascular conduits.
Chemotherapeutic agents, blood products and hyperalimentation solutions have been administered and recurrent diabetic ketoacidosis has been treated via vascular access procedures in 13 patients during the period from 1972 through 1977. Bovine heterograft, saphenous vein graft and the direct arteriovenous fistulae have been successfully utilized in the construction of arteriovenous fistulae in patients requiring vascular access for nonhemodialysis purposes. Operative techniques and therapeutic usefulness are discussed.
A technique, using radioactively-tagged microspheres to measure the blood flow in delayed axial pattern flaps in the pig, is presented. The blood flow was significantly (p less than 0.01) increased in the delayed portion of these flaps, reaching maximal levels after 4 to 12 days of delay. Also, the blood flow to these flaps correlated with tissue survival during the first week after the delay (p less than 0.001).
Blood flow was investigated in 112 skin flaps (84 delayed and 28 undelayed) in 28 pigs. The flow was significantly (P less than 0.001) increased over the control flow with increasing delay intervals, reaching the greatest flow at one week after the delay (paralleling the increase in tissue survival). This increased blood flow persisted after definitive flap raising. The circulatory adjustments within the first week of the delay constitute the delay phenomenon, and they determine the ultimate viability of the skin flap in this model.
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Sixteen cases of cervical thymic cyst are added to the previously reported fifty-six cases. Seventy-five per cent of the patients were less than twenty years old. Eighty per cent complained of a painless mass preoperatively. The histologic diagnosis of cervical thymic cyst was made if thymic epithelial elements could be found adjacent to the cyst cavity; Hassall's corpuscles were usually present. Cholesterol granulomata could usually be identified. The theories of origin of cervical thymic cyst are discussed.
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Four months postradical lymphadenectomy and pelvic irradiation for Stage I teratocarcinoma of the testis, a patient was found to have an internal strangulated herniation of small bowel beneath the right iliac artery. The operative management is discussed, and the literature is reviewed concerning the etiology of small bowel obstruction in postoperative, irradiated patients and the techniques of peritoneal closure.
Duodenocolic fistula has been reported as the result of a variety of benign and malignant processes, but rarely from a pancreatic carcinoma. Such a case in a young adult is presented. The literature is reviewed; a single duodenocolic and two gastrocolic fistulas secondary to adenocarcinoma of the pancreas have previously been reported.
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