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Biomedical subjects

A R Shons

Publications and source records attributed to A R Shons.

At least 19 recordsLinked to original sources
PubMed1992

Silicone breast implants and immune disease.

Silicone was originally regarded as inert in the human body. Silicone medical devices have been associated with various complications that may involve an immune reaction to silicone or a silicone organic complex. There have been more than 80 cases reported in the medical literature of a varied systemic autoimmune illness in patients who have had various foreign materials placed in the breast. Controversy exists as to which complications have a cause and effect relationship, and which represent coincidental findings. It is difficult to distinguish between nonspecific local reactions and reactions that have an immunological basis. Approximately 1,000,000 to 2,000,000 women in the United States have had silicone breast implants inserted for reconstruction or augmentation mammaplasty; 28 of those patients have been reported to have developed a systemic autoimmune disease. Data on the 28 reported cases do not in any way prove a causal relationship between breast implants and immune disease. Given the natural incidence of autoimmune diseases, we would expect a coincidental occurrence in the United States of more than 1,000 cases of autoimmune disease in women who had undergone breast implant surgery. Additional information must be obtained to resolve the question. The true incidence of autoimmune disease in patients with implants needs to be determined. A prospective registry of implant patients should be established and comprehensive retrospective information obtained on the implant patient population. Further experimental work is necessary on the bioreactivity of silicone. Patients with implants and autoimmune disease, once identified, must be carefully evaluated by physicians who are experienced in the treatment of autoimmune disease.

Autoimmune Diseases↗
PubMed1986

Limb allotransplantation in the rat: extended survival and return of nerve function with continuous cyclosporin/prednisone immunosuppression.

We report the variability of the rejection process among the several tissues of a limb allograft. We used a rat hind limb allograft model transplanting across a well-defined minor histocompatibility barrier (Fischer RT-1(1v1)), donor animals, and Lewis (RT-1(1)) recipient animals. Continuous cyclosporin and prednisone immunosuppression was used. Four immunosuppressive regimens all produced extended limb survival. The rejection process was most severe and difficult to control in the skin. Nonskin tissues reverted to a nearly normal appearance after a period of cellular infiltration 2 to 3 weeks posttransplantation. Clinical and electromyographic evidence of nerve regeneration and end-organ reinnervation was demonstrated in long-term surviving animals.

Animals↗
PubMed1985

Multiple primary epidermoid carcinomas of the upper aerodigestive tract.

In a series of 405 patients with epidermoid carcinoma of the head and neck, 52 patients (13%) developed multiple epidermoid carcinomas of the upper aerodigestive tract. Subsequent primary tumors developed with nearly equal frequency in the head and neck, lung, and esophagus. Forty of the patients developed a subsequent primary carcinoma within five years of the first. Thirty-eight (73%) of the patients who developed a subsequent primary carcinoma survived less than two years from its diagnosis. The majority (34/50) of the patients died from the subsequent primary carcinoma. We recommend that panendoscopy and an esophagogram be performed on initial evaluation of patients with head and neck cancer. A thorough reexamination is warranted if new symptoms or signs develop.

Adult↗
PubMed1984

Aggressive surgical therapy after irradiation failure in treatment of cancer of the oral tongue.

Fifty-three consecutive unrandomized patients with squamous cell cancer of the oral tongue were retrospectively studied to compare the results of an aggressive surgical approach performed as primary therapy or as salvage after irradiation failure. Twenty-five patients underwent surgery primarily, while 23 of 28 patients treated with curative irradiation required surgical salvage. Tumor staging was equivalent between the two groups. Local recurrences at the site of origin of the tumor within two years postoperatively were significantly more frequent in salvage patients (10.0%) than in primary surgical patients (5.5%). Cervical lymph node recurrences within five years were more frequent in the salvage surgery group (74.8% v 36.7%). Systemic metastases developed in a similar proportion in both groups. Determinate five-year survivals were nearly identical (55.2% v 55.5%). Although recurrence rates were significantly higher after irradiation and salvage surgery, an aggressive surgical effort in patients who are irradiation failures can result in five-year survival rates matching those of surgical patients.

Adult↗
PubMed1984

The results of aggressive regional operation in the treatment of cancer of the floor of the mouth.

We reviewed the records of 94 patients with cancer of the floor of the mouth who were treated during a 15-year period to assess the results of an aggressive regional surgical approach. The primary tumor was excised with a 2 cm margin of normal tissue. A marginal or segmental mandibulectomy was performed in 84 of 94 patients. An ipsilateral radical neck dissection was performed in 86 of 94 patients. Contralateral suprahyoid dissection was combined with ipsilateral radical neck dissection in 52 patients. Bilateral radical neck dissection was performed in 10 patients. In the 1 to 16-year follow-up period, local/regional control was achieved in 91% of stage I patients, 83% of stage II patients, 68% of stage III patients, and 48% of stage IV patients. Determinant 5-year survival rates were T1--72%, T2--47%, T3--25%, and T4--28%.

Adult↗
PubMed1983

Early histopathologic changes in experimentally replanted extremities.

Early serial histologic changes in replanted extremities have not been well defined; their contribution to a suboptimal functional result is unknown. With the use of a rat hind limb replantation model to address this question, we studied tissues of the replanted legs by light microscopy from 1 to 60 days after replantation. Although early lesions were consistent with ischemic injury, the chronic preparations were remarkably normal, and the lesions were more consistent with denervation. Poor function in clinical replantations may be a reflection of more pronounced versions of these pathologic lesions.

Animals↗
PubMed1983

The use of methyl methacrylate in a two-stage correction of Crouzon's/Apert's deformity.

We have employed a two-stage operative approach to the correction of Crouzon's/Apert's deformity. Extensive use of methyl methacrylate in cranioplasty and frontal bone advancement is employed to obtain finely detailed contours with excellent stability. By adhering to principles of separation of oral contamination and the methyl methacrylate, as well as the provision of adequate soft tissue coverage of the methyl methacrylate, the problems of infection and soft tissue breakdown can be minimized.

Acrocephalosyndactylia↗
PubMed1983

Facial fractures in trauma victims: the influence of treatment delay on ultimate outcome.

To obtain objective data on the consequences of delayed treatment of facial fractures we reviewed the records of 220 patients who had suffered facial fractures concomitantly with extrafacial trauma severe enough in its own right to warrant hospital admission. Fractures studied were those of the mandible, maxilla, zygoma, and frontal sinus. Seventy-three patients fit inclusion criteria. Most injuries occurred in motor vehicle accidents. Associated extrafacial injuries were common and frequently multiple, the more serious of which generally took priority over the facial injuries in the triage system. The two most common reasons for delay were instability of the patient's neurological status, or initial non-recognition or poor definition of the facial fracture. Delays in treatment ranged from 0 to 24 days. In patients with mandible fracture only, delay of up to 24 days in definitive treatment led to no noticeable increase in morbidity due to malocclusion, infection, or nonunion. In no other facial fracture did treatment delay lead to an increased incidence of complications. Retrospective analysis of the patients who did suffer complications almost always revealed predisposing conditions that placed these patients at higher risk for poor results.

Adolescent↗