Biomedical subjects
Publications and source records attributed to C Paletta.
PURPOSE: A technique for introducing anoderm into the anal canal is described. METHODS: An internal pudendal flap was used. RESULTS: This technique was totally successful in alleviating anal stenosis and maintaining fecal continence. CONCLUSION: Internal pudendal flap should be in the armamentarium of the colon and rectal surgeon for treating severe anal stenosis.
A 32 year old man was admitted for dyspnea, hemoptysis, macroscopic hematuria, hypertension (140/100), peripheral edema and hemodynamic decompensation. Lung Xrays revealed pulmonary edema and a cavity in the left apex. Laboratory determinations revealed an altered renal function with increased creatinine and urea levels and nephrotic syndrome. There was leucocyturia, hematuria and cylindruria. The sputum showed a large number of acid-fast bacilli. The patient began anti-tuberculosis treatment with three drugs (isoniacid, rifampicin, pirazinamide). On ultrasonography, both kidneys revealed ecogenic lesions with size, shape and cortico-medular relationship preserved. The patient persisted with altered renal function, steady levels of urea nitrogen, creatinine and potassium, preserved diuresis and hypertension. Bidimensional echocardiogram: LVDD 55 mm, hypoquinetic septum, pericardic effusion, thickened pericardium, pleural effusion, shortening fraction decreased. He received treatment for this congestive cardiac failure and hypertension with enalapril, nifedipine and fursemide. A percutaneous renal biopsy was performed with anatomopathologic diagnosis of diffuse encocapillar proliferative glomerulonephritis with crescents (15%) and total glomerular sclerosis (33%). Immunofluorescence: positive, immune-complexes with IgM and C3. The patient gradually recovered his normal renal function, improved his pleural effusions and normalized his cardiac function. He was discharged in good clinical condition on the 69th day of anti-tuberculosis treatment. An association between pulmonary tuberculosis and glomerulonephritis is discussed. It is proposed that renal lesions might be the consequence of the tuberculosis due to the sedimentation of circulating immune-complexes.
As our population ages and spinal cord injuries continue at their present rate due to motor vehicle accidents and handgun injuries, the development of pressure sores will most likely increase in frequency. The three major populations at risk to develop pressure sores include the elderly, long-term hospital patients, and neurologically impaired patients. the posterior thigh flap evolved during our experience with the lower extremity muscle flaps. We have used 22 posterior thigh flaps in 21 patients. We have found that it is a reliable flap with a dependable blood supply that can be used in the soft tissue coverage of trochanteric, ischial, and some sacral wounds. In addition, the posterior thigh flap can be used as a pedicled flap in the management of heel and foot wounds. In this review, the anatomy and application of the posterior thigh flap are elaborated.
Controversy over the safety of breast implants has increased significantly over the past several years. Several companies have discontinued their manufacture of silicone implants. Although there have been reports of breast cancer developing in a patient who previously had undergone breast augmentation, a review of the literature has failed to reveal a patient with cancer arising from the breast implant capsule. We present a woman with squamous cell carcinoma apparently arising from an implant capsule 15 years after breast augmentation.
Tissue expanders are particularly applicable in the pediatric population. They are extremely well tolerated by children and can withstand the everyday play and trauma unique to children. Over the past 2 years, we have used 26 tissue expanders in 17 pediatric patients. Fifteen of the 17 patients successfully underwent reconstructive surgery with the aid of expanders. The expander became exposed in two patients, necessitating removal. In each of these patients, a more complicated and less satisfactory method of reconstruction was performed.
The need for revascularization procedures in individuals with hand ischemia is uncommon. Previous reports describe the successful utilization of reversed saphenous vein to reconstruct the distal vasculature of the arm. This case report details the use of in situ arm vein to restore perfusion to a threatened hand.
Hidradenitis suppurativa is a chronic, relapsing, inflammatory disease process that primarily involves the axilla and/or inguinal region and does not manifest itself until after puberty. Typically, the process begins as a local occlusive disease of a sweat gland; secondary bacterial infection then occurs. The early stages of hidradenitis suppurativa are usually managed by the dermatologist. Once the disease becomes extensive and chronic, surgical excision of all the involved tissue is indicated.
Women who select conservative treatment for carcinoma of the breast (tumor excision followed by supervoltage radiation therapy) place a premium on breast preservation and aesthetics. When local control fails and they require a mastectomy, or when the aesthetic appearance is unacceptable, they may request breast reconstruction. The goal of this study is to evaluate a series of 10 patients who required reconstructive breast surgery after complications of conservative treatment. Patient classification: I. Breast or chest wall necrosis (3). II. Breast fibrosis and gross asymmetry (3). III. Local recurrence of breast cancer (5). IV. Positive margins after the initial lumpectomy (1). The mean age was 34 years. Radiation dosage average was 5252 rads with two patients receiving iridium-192 implant boosts. The reconstructive management was complex and usually required a major musculocutaneous flap because of the radiation effects.