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Biomedical subjects

D A Hudson

Publications and source records attributed to D A Hudson.

At least 73 records · Page 4Linked to original sources
PubMed1996

Velopharyngeal incompetence after adenotonsillectomy in non-cleft patients.

This report discusses 15 non-cleft palate children who developed velopharyngeal incompetence (VPI) after adenotonsillectomy. Eight boys and 7 girls with a mean age of 6.2 years (range 4.3-11 years) were treated between 1970 and 1993. After 2 years conservative management to allow for spontaneous resolution, only (7 children) 47% achieved normal resonance. Speech therapy was employed mainly for those patients with unrelated articulation errors. Fifty-three percent (8 children) required surgery for persistent hypernasality and in 6 a pharyngoplasty was performed and in one child a posterior pharyngeal cartilage graft was inserted. One case is still to have surgical intervention. Half of the non-cleft children who develop VPI after adenotonsillectomy will respond to conservative management.

Adenoidectomy↗
PubMed1996

The surgically delayed unipedicled TRAM flap for breast reconstruction.

Surgical delay is one method of enhancing the vascularity of the lower abdominal transverse rectus abdominis musculocutaneous (TRAM) flap. The outcome of 7 patients who underwent surgical delay (by ligating both superficial and deep inferior epigastric vessels bilaterally) a week prior to definitive TRAM flap elevation is described. Three patients were smokers, 3 were obese, and 1 was an asthmatic on medication. A satisfactory aesthetic result was achieved in all patients and the complications that occurred were minor. Two patients developed minor skin necrosis due to inadequate trimming of zone 4 on the contralateral side to the pedicle and there were 3 cases of fat necrosis, which occurred below Scarpa's fascia. Surgical delay is a useful technique of breast reconstruction. It allows the flap to be centered safely in the lower abdomen. In the high-risk patient, delay may prevent the need for microsurgery or the sacrifice of both recti.

Adult↗
PubMed1996

Missed closed degloving injuries: late presentation as a contour deformity.

Closed degloving injuries are uncommon, and the diagnosis may be missed at the time of acute trauma. This study reports on seven patients seen during a 5-year period who presented with a contour deformity a number of months after the initial closed degloving injury. The median time to presentation was 1.4 years. In five of the seven patients, the contour deformity was present on the lateral thigh, and in two patients it occurred on the calf. Liposuction was employed to treat five patients, and all these patients reported an improvement in the contour of their limb. In two patients, because of an irregular, gritty deformity, liposuction was unsuccessful, and an open approach was required. The closed degloving injury with a contour deformity usually follows a pedestrian-motor vehicle accident. These patients present months later requesting corrective cosmetic surgery. Liposuction will improve the silhouette in most patients, but an open approach may be required where fat necrosis and heterotopic calcification have occurred.

Female↗
PubMed1996

Melanoma of the foot in white South Africans.

There have been few studies that have compared the outcome of treatment of melanoma on the sole and dorsum of the foot or defined their prognostic factors. We describe 44 white patients (30 women and 14 men, mean age 53 years) with melanoma on the foot (sole, n = 25, dorsum, n = 19) seen over a 15 year period. Forty patients presented with stage I, two with stage II, one with stage III, and one with stage IV disease. The median Breslow depth of penetration was 2.8 mm (sole 3.3, dorsum 2.3). Of the 40 patients with stage I disease, 34 patients (17 dorsum, 17 sole) were treated by wide local excision (2 cm or more) and none developed local recurrence. Six patients (five sole, one dorsum) who had narrow excision margins (less than 1 cm, stage I disease) developed local recurrences. Ten patients underwent prophylactic hyperthermic limb perfusion. Sixteen patients with stage I disease (10 sole, six dorsum) developed metastases in the inguinal nodes. All 16 underwent block dissection of the nodes and five are alive. The overall survival for both dorsum (73%) and sole (66%) (stage I disease) was similar at 60 months. Both patients with stage II disease were alive at the time of writing, but the two patients with stage III and IV disease had died. The foot is an anatomical subsite associated with a poor prognosis for melanoma. There is little difference in prognostic factors and outcome between the sole and dorsum.

Adult↗
PubMed1996

Surgical treatment of metastatic melanoma of the small bowel.

Eighteen of 1420 patients with primary cutaneous melanoma presented with symptomatic small bowel metastases and were reviewed to establish the role and efficacy of surgical intervention. The median interval between treatment of the initial skin lesion and detection of the intestinal metastases was 4.4 years (range, 2 months to 15 years). Most patients presented with either anemia, abdominal pain, bowel obstruction, or intussusception. In six patients, small bowel involvement was the first sign of metastatic disease. Seventeen of the 18 patients underwent laparotomy, and all overt metastases were completely excised in 12. Three patients died postoperatively. Fourteen of the 17 patients had satisfactory palliation with complete symptomatic relief. Median survival after resection was 13 months (range, 2 days to 300 months). Median survival of the 12 patients in whom all macroscopic disease was resected was 44.5 months (range, 2-300 months), whereas the median survival in the four with incompletely resected tumors was 4 weeks (range, 2 days-24 weeks). Five of 12 patients who underwent complete resection of small bowel metastases survived more than 6 years, 3 of whom remain well and free of disease at 6, 14, and 25 years. These results justify active surgical intervention in patients with symptomatic small bowel metastatic melanoma, both for relief of symptoms and prolongation of life.

Adolescent↗
PubMed1995

The use of tissue expansion in children with burns of the head and neck.

The outcome of 25 children who underwent reconstruction of the head and neck with tissue expanders is described. Fourteen boys and 11 girls with a mean age of 6.2 years (range 3-11 years) had 36 tissue expanders inserted. Five of the expanders extruded and five children suffered other expander-related complications. The best aesthetic results were achieved in the scalp and the poorest results occurred where expanded neck skin was transposed into the face. Tissue expansion is a useful method for reconstruction of the head and neck in burned children. However patients require careful selection in order to achieve optimal results. Meticulous attention to detail is required to reduce the incidence of complications.

Burns↗
PubMed1995

Hot water burns in Cape Town.

Scalds are common in South Africa and accounted for 21.6 per cent of the admissions to the Burns Unit of the University of Cape Town. Two hundred and forty adult patients (160 males, 80 females) with a mean age of 34.2 years were admitted for treatment of scalds between 1985 and June 1992. One hundred and thirteen sustained their scalds accidentally while 127 patients were assaulted with hot water. Epilepsy accounted for 11 per cent of the accidental burns. The head and neck was involved in 16.8 per cent of accidental burns and in 84.9 per cent of assaults. A quarter of the scalds to the trunk and limbs were caused by assault compared with 75 per cent caused by accidents. Beta haemolytic streptococcus was the second commonest organism isolated from the burn wound (57 patients). In 19 per cent of these patients a weekly course of penicillin and erythromycin did not eradicate the streptococcus and clindamycin was required. Accidental scalds usually affect the lower body and limbs whereas assault with hot water commonly involves the head and neck. Streptococcus is a common organism in the Burns Unit and is becoming more difficult to eradicate.

Adolescent↗
PubMed1995

Treatment of velopharyngeal incompetence by the Furlow Z-plasty.

Velopharyngeal incompetence occurs in approximately 25% of cases after primary palatoplasty. There is controversy regarding the best method of surgical management of velopharyngeal incompetence. Between 1986 and 1993, 13 children with velopharyngeal incompetence after primary palatoplasty underwent Furlow Z-plasty repair. All children were assessed by a speech therapist and with videofluoroscopy pre- and postoperatively. The Furlow Z-plasty was performed at a mean age of 7.8 years (range, 4-12 years). Eleven children achieved normal resonance, and all 13 demonstrated improved velopharyngeal function on videofluoroscopy. The Furlow Z-plasty is effective treatment for children with velopharyngeal incompetence.

Child↗
PubMed1995

Speech results after repair of the cleft soft palate.

The purpose of this study was to investigate the speech results of five different techniques of repair of only the cleft soft palate and also to assess the effect of timing of repair on speech results. A total of 184 patients (73 males, 111 females) underwent either a Dorrance repair (25 patients), a Wardill repair (41 patients), a Perko repair (19 patients), a von Langenbeck repair (79 patients), or a Furlow Z-plasty (20 patients) between 1964 and 1989. Articulation, intelligibility, and resonance were assessed by usually two but at least one speech therapist. All the children underwent videofluoroscopy. The follow-up period was from 3 to 24 years, with a mean of 9.6 years. The Furlow Z-plasty and Perko repair yielded the best speech results. There was a significant difference in speech and less velopharyngeal incompetence (Fisher's exact test, p = 0.0218) when the palate was repaired prior to 6 months of age as compared with after 6 months of age (for all the techniques except the Dorrance repair). Fistulas are uncommon after repair of only the soft palate.

Child↗
PubMed1995

Subungual melanoma.

Twenty (1.5%) of 1,350 patients with malignant melanoma treated during a 17-year period had their primary lesion in the nail bed. The thumb (5 patients) and big toe (7) were the most commonly involved digits. Mean delay before diagnosis was 1.4 years. Thirteen patients were black and 7 white. Eight patients (40%) were initially misdiagnosed as having traumatic, infective or benign lesions. Four patients presented with recurrent local disease after inappropriate nail excision or inadequate nail biopsy, while 2 patients had regional nodal spread and 2 had systemic metastases. Mean Breslow depth was 5.7 mm. The histogenetic subtypes were acral lentiginous melanoma (12 patients) and nodular melanoma (4 patients); 4 lesions were unclassifiable. All patients underwent amputation of the involved digit and 12 required node dissection (therapeutic in 11, prophylactic in 1). Five patients (25%) are alive (mean 52 months, range 29-99 months); 4 are disease-free and 1 has brain metastases. Overall median survival was 32 months with a 26% 5-year survival rate. Delayed diagnosis and advanced disease at presentation contributed to the poor prognosis in nail bed melanoma.

Adult↗
PubMed1995

Results of 3 cm excision margin for melanoma of the scalp.

Local recurrence and survival were evaluated in 19 patients with melanoma of the scalp after conservative local treatment using a standard protocol of 3 cm excision margins and split skin grafting. Sixteen men and three women had a mean age of 46 years. 12 presented with stage I disease, one with stage II, five with stage III, and one with stage IV disease. Nodular melanoma was present in 16 patients. 17 patients had either Clark level IV or V lesions and mean Breslow depth was 3.4 mm (range 0.9-25). Local recurrence occurred in only one patient who had an excision biopsy performed. Six of 12 patients with stage I disease developed regional adenopathy and only 2 are alive after therapeutic block dissection. All patients with stage III and stage IV disease have died. Excision using 3 cm margin is adequate to control local disease. Scalp melanoma is a specific anatomical subsite associated with a high incidence of regional disease and has a poor prognosis. This high risk group of patients may benefit from elective lymph node dissection.

Adolescent↗
PubMed1995

Flexor pollicis longus tendon injuries in children.

Tendon injuries to the thumb are uncommon in children. Nine children (mean age 6.1 years) with isolated complete injuries to the flexor pollicis longus (FPL) were treated with primary suture and controlled mobilisation at a major referral centre between 1985 and 1992. Five injuries occurred in zone II, two in zone III and two in zone V. One child developed sepsis and there were no cases of tendon rupture. Good or excellent results (Buck-Gramcko criteria) were achieved in seven of the nine children. Pinch grip after repair was similar to the non-injured hand. Primary repair and early controlled mobilisation of FPL leads to satisfactory results in children.

Child↗
PubMed1995

Melanoma in black South Africans.

BACKGROUND: Scant data exists on melanoma in blacks from Africa. This study was undertaken to define factors affecting outcome of blacks from South Africa with melanoma. STUDY DESIGN: A retrospective analysis of the management and outcome of 63 black patients with malignant melanoma treated at a major referral center during a 14 year period is presented. Data evaluated included patient demographic and clinical characteristics, stage at presentation, tumor site, histologic type, treatment, and subsequent cure. Survival curves were calculated for stage and site of disease. RESULT: The mean age at presentation of the 39 women and 24 men was 60.5 years (range of 30 to 85 years), with a peak incidence in the sixth decade. The foot was the most common site of disease (45 patients). Seven patients had subungual melanoma, seven had primary mucosal lesions, and in six, the primary lesion could not be found. Thirty patients presented with stage I disease, two with stage II, 23 with stage III, and nine with disseminated metastatic disease. Acral lentiginous melanoma was the most common histogenetic type (34 patients), nodular melanoma occurred in ten patients, and superficial spreading melanoma occurred in three patients. The mean Breslow depth was 6.15 mm (range of 1 to 25 mm). Patients with localized disease were treated by wide local excision and split skin graft, while patients with melanoma in the nailbed were treated by amputation of the involved digit. Sixteen patients are alive after a mean follow-up period of 82.1 months, 44 have died after a mean of 12.7 months, and five patients have been unavailable for follow-up evaluation. CONCLUSIONS: The poor prognosis in black patients in South Africa is the result of delayed presentation with thick primary lesions and advanced disease. An active education program may reduce mortality by detecting the disease earlier.

Adult↗
PubMed1994

The role of suprahyoid block dissection in carcinoma of the floor of the mouth.

The efficacy of suprahyoid block dissection combined with radiotherapy, in the management of neck nodal disease was evaluated in 15 patients with carcinoma of the floor of mouth (abutting on the mandible) between 1983 and 1989. Ten males and 5 females had a mean age of 60.3 years. Suprahyoid block dissection was performed in 10 patients as initial treatment. Nine of these presented with a submandibular mass and one patient with a T4NO lesion had a prophylactic block performed. Suprahyoid block dissection was performed in five patients who developed a submandibular mass after completion of surgery and radiotherapy. Wound sepsis occurred in three patients, but resolved with conservative treatment. Clinical assessment of the suprahyoid mass was accurate in 65% of patients. Nodal recurrence occurred in one patient. Seven patients are alive and disease free after a mean of 64.5 months. Two other patients are alive, one with lung metastases, and one with a supraclavicular mass. Six patients have died, two of whom developed local recurrence, one who developed a supraclavicular mass, one after nodal recurrence, one with lung metastases, and one of an unrelated cause. Suprahyoid block dissection combined with radiotherapy is effective treatment for nodal control of patients with carcinoma of the floor of mouth. This procedure is associated with a low morbidity.

Adult↗
PubMed1994

Flexor tendon injuries in children.

Flexor tendon injuries in adults differ from those in children. 38 children (22 male and 16 female) with a mean age of 6.7 years were treated for flexor tendon injuries by primary suture and controlled mobilization between 1985 and 1992. 53 flexor tendons were injured (average 1.5 digits per patient) and the injury most commonly affected the little finger (23 patients). 60% of injuries occurred in zone 2. Using Lister's criteria, 82% achieved excellent or good results. Repair of both FDS and FDP was better than repair of FDP alone, even in zone 2. There were three tendon ruptures (all classified as poor results) and one other poor result occurred in a zone 2 injury with an associated ulnar nerve palsy. The outcome after flexor tendon repair in children is better than in adults in our hands because rapid healing of tendons occurs in children. No child has yet required tenolysis because in children adhesions are more pliable. Both flexor tendons should be repaired irrespective of the zone of injury. A functional hand can be expected after flexor tendon repair in children.

Adolescent↗
PubMed1994

Respiratory distress secondary to scalds in children.

Respiratory distress secondary to scalds in children is rare. We report 13 children (six girls and seven boys) with a mean age of 19 months who sustained this injury, who were admitted to a major referral hospital during a 5.5-year period. Associated scalds usually to the face were always present and the mean total burn surface area (TBSA) was 14.4 per cent (range 3-30 per cent). Stridor was the most common presenting symptom with a variable time of onset. Bronchoscopy was performed in 11 children and in nine the injury was confined to the supraglottic area. Five children were treated with epinephrine nebulization and the symptoms resolved in 3-4 days, one child had a prophylactic tracheostomy. Seven children required intubation and ventilation. Three children died, two of whom sustained burns to both the upper and lower respiratory tract. Respiratory distress secondary to scalds may not be recognized or the progressive nature of the injury not appreciated. In three-quarters of our patients the injury was confined mainly to above the glottis. Children with inspiratory stridor can be managed with epinephrine nebulization but more marked respiratory distress requires intubation and ventilation. Mortality was due to direct thermal injury to the respiratory tract and secondary bronchopneumonia.

Burns↗
PubMed1994

Primus stove burns in Cape Town: a costly but preventable injury.

The management and outcome was evaluated in 33 patients during an 18-month period, who sustained burns as a result of working with a primus stove. There were 17 females and 16 males with an average age of 32.5 years. Twenty-nine patients were black skinned and four were coloured skinned. The average burn surface area was 16.8 per cent and the burns were deep dermal in all; 48 per cent of patients also had areas of full thickness skin loss. Twenty-seven patients were burned in more than one anatomical area. Patients spent an average of 24 days in the burns unit and all patients required tangential excision and skin grafting at least once. The average number of units of blood required was four. Only one patient died. Primus stove burns occurred in people of poor social circumstances. Primus stove burns place a heavy burden on the economic resources available. Prevention is the key to management.

Accidents↗