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Biomedical subjects

D A Hudson

Publications and source records attributed to D A Hudson.

At least 91 records · Page 5Linked to original sources
PubMed1994

Hand infections secondary to fish bone injuries.

Hand injuries associated with fish bones and fin spines are not common but can cause morbidity out of proportion to the original injury. This is because such injuries often leave residual fragments of foreign organic matter in the tissues, leading to troublesome secondary infections. This report details 1 year's experience with nine hand infections after fish bone injury in a busy regional hand surgery referral centre. There were five males and four females with an average age of 45 years. Radiographs taken on presentation in five patients revealed a radiolucent foreign body in only two patients. Two patients presented with a flexor tendon sheath infection, three with a pulp space infection, one with infection of the hypothenar space, one with a subungual infection, one with cellulitis of the dorsum of the hand and one with an abscess on the dorsum of the hand. Antibiotics were prescribed for six patients and all patients except the one with cellulitis of his hand underwent surgical débridement. A single surgical procedure was adequate in five patients. One patient with a hypothenar space infection only had the foreign body removed during the third surgical débridement. The two patients with flexor tendon sheath infections required ray amputation. Fish bones cause a number of different infections in the hand. A foreign body should always be sought even if not present on the radiograph. Antibiotic selection should be tailored to eradicate the causative organism.

Adult↗
PubMed1993

Plantar melanoma in black South Africans.

The outcome of treatment in 40 black patients (27 women, 13 men; mean age 62.9 years) with plantar melanoma over a 13-year period was analysed to evaluate the efficacy of wide local excision with split skin grafting. Substantial delay in seeking medical attention occurred in 35 patients. At presentation, 20 patients had stage I disease, one stage II, 15 stage III and four stage IV. Acral lentiginous melanoma (27 patients) was the most common histological type. The mean Breslow depth was 6.9 mm and 35 patients had lesions of Clark level IV or V. The mean surface area or plantar lesions was 13.3 cm2. Wide local excision with split skin grafting was used in 29 patients; four patients with neglected advanced plantar lesions had below-knee amputation and seven with metastatic disease did not undergo surgery. Graft sepsis occurred in six patients and local recurrence in two. Nine patients were alive at follow-up; the 5-year survival rate was 25 per cent. Delay in presentation and locally advanced disease may explain the poor prognosis of plantar melanoma in black South Africans.

Adult↗
PubMed1993

The management of skin infarction after meningococcal septicaemia in children.

The clinical course and management of 21 children (12 females, 9 males; mean age 2.4 years) with skin necrosis secondary to meningococcal septicaemia is described. Skin necrosis was most commonly sited in the lower limbs (20 patients). Sixteen patients had multiple areas of involvement and amputation of the digits was required in 5 patients. One required an above knee amputation. Small areas of skin necrosis were managed conservatively (4 patients) but larger areas required debridement and grafting. Skin grafting was delayed in 15 patients and graft loss occurred in 8. Multiple grafting procedures were required in 6 patients. Scar revision was required in 6 patients. Nutritional support is also an important component of management.

Amputation, Surgical↗
PubMed1993

The modified Z-plasty for unilateral cleft lip repair.

In 1965 Davies described a Z-plasty technique for the repair of a unilateral cleft lip. The technique has been modified so that the scars are more aesthetically placed and the orbicularis muscle correctly aligned. A prospective study was performed comparing the results of this modified Z-plasty with the rotation advancement repair. Twelve patients had a modified Z-plasty and 10 a rotation advancement repair. The modified Z-plasty compares favourably with the rotation advancement technique for the repair of a unilateral cleft lip. In particular, the incidence of asymmetry of lip height was greater in the rotation advancement group.

Child↗
PubMed1993

The spaghetti wrist. Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist.

The outcome of 15 patients who sustained simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist is described. Primary nerve repair yielded satisfactory results, the median nerve achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement. Flexor tendons yielded the poorest results. A functional, albeit impaired outcome can usually be anticipated following this severe injury.

Adolescent↗
PubMed1993

Assault inflicted by hot water.

Assault inflicted by hot water is uncommon although such injuries have been reported from many parts of the world. The patient characteristics, burn distribution and outcome in 127 patients who had been intentionally assaulted with hot water during a 7 1/2 year period are reported. More than half of the males were assaulted by their wives. The female was often assaulted by her spouse or another family member. Most patients came from lower socioeconomic groups. The average burn surface area was 13.7 per cent (range 1-45 per cent). The upper part of the body was much more frequently burned than the pelvic and lower limb areas (12 per cent). Males (94) were assaulted more commonly than females (33). Eighty-four patients suffered partial skin thickness burns requiring debridement and skin grafting. The average hospital stay was 17 days (range 1-61 days). Upper body hot water burns in adults should raise the possibility of assault in the minds of attending medical personnel, especially where predisposing factors exist (alcohol abuse, lower socioeconomic strata, poor education). Most patients sustain partial skin thickness burns and will require debridement and grafting. Psychosocial factors require investigation and professional intervention.

Adolescent↗
PubMed1993

Brachial plexus injury after median sternotomy.

Serious brachial plexus injury after median sternotomy is uncommon. However, affected patients experience considerable morbidity and their return to regular employment is often delayed. The pathogenesis of the injury is multifactorial. Wide sternal retraction is the major etiologic factor. Management is primarily conservative and should be guided by a team experienced in upper limb and hand surgery. Our experience at a major referral center during a 3-year period is described.

Adult↗
PubMed1992

Impacted knife injuries of the face.

Impacted knife injuries of the face are uncommon. Associated vascular, ocular and neurosurgical injuries should be excluded. The impacted knife should be removed in theatre. Four patients who presented with this injury are discussed.

Adult↗
PubMed1992

Neutral amino acid transport in an androgen-dependent epithelium.

1. Transport of neutral amino acids by the isolated seminal vesicle epithelium of normal and gonadectomized guinea pigs has been investigated by measurement of the uptake of 2-amino[1-14C]-isobutyric acid and 2-methylamino[1-14C]isobutyric acid. 2. The Vmax for Na-dependent and -independent transport of both amino acids was reduced by gonadectomy but the general transport characteristics appeared to be unchanged by this treatment. 3. The most likely explanation of the decreased transport is the loss of transporter molecules associated with the tissue regression that follows rapidly on gonadectomy.

Amino Acids↗
PubMed1992

Constitutive protein secretion by guinea-pig seminal vesicle epithelial cells.

1. Secretion of pulse-labelled protein by the isolated epithelium of guinea-pig seminal vesicle epithelium was rapid, unaffected by cholinergic and adrenergic drugs, cyclic nucleotides or changes in the sodium, potassium and calcium concentrations of the "chase" medium. 2. Low temperature, NH4Cl, hyper- and hypo-osmolarity and membrane-stabilizing agents inhibited secretion which was also dependent on aerobic metabolism. 3. Monensin reduced secretion of the six labelled, relatively low molecular weight proteins recovered from the medium in a concentration-dependent, apparently non-specific manner.

Animals↗
PubMed1992

Instrumentation of curved root canals: a comparison study.

Flex-R, Flex-O, and K-Flex files were compared using a circumferential filing technique on 30 extracted human molars. The buccal canals of maxillary molars and mesial canals of mandibular molars were utilized. The minimal initial curvature was 18 degrees. Canal curvature was measured before and after filing, and changes were analyzed statistically. Analysis showed that, no matter which of the instruments was used, the angle of curvature was maintained with a high degree of accuracy.

Dental Instruments↗
PubMed1992

Closed degloving injuries: results following conservative surgery.

Closed degloving wounds are uncommon but important injuries because they may be overlooked in the multiply injured patient and, if not treated correctly, may give rise to significant morbidity. This prospective study reports the results of a conservative surgical management policy in 16 patients with closed degloving wounds treated during a 1-year period in a tertiary referral center. Motor vehicle accidents caused most of the injuries, 69 percent of which occurred on the lower limb. The extent of injury ranged from 2 to 12 percent (mean 4.9 percent) of the total body surface area. The diagnosis of closed degloving wound was missed at initial assessment in one-third of patients. A uniform management policy with drainage of the degloved area through a small incision followed by compression bandaging was applied. The volume of blood and necrotic fat evacuated ranged from 15 to 800 ml (mean 120 ml). One patient with necrotic skin initially had excision and primary wound closure performed. Delayed necrosis occurred in one patient in whom extensive degloving occurred and effective compression could not be applied. Ultimate flap viability using this technique was excellent, since only 1 of 16 patents required skin grafting.

Accidents, Traffic↗
PubMed1991

Delay in the diagnosis of cutaneous malignant melanoma. A prospective study in 250 patients.

The extent and consequence of patient and professional delay in the diagnosis and treatment of 250 consecutive patients with primary cutaneous malignant melanoma was investigated. Mean total delay from the onset of observed change in a melanoma to appropriate therapy was 11.1 months. The major component of delay (9.8 months) was patient related. Seventy-nine (31.6%) patients waited more than 6 months before seeking medical attention. Few patients recognized early melanoma, and 46% responded only to late features (i.e., ulceration or bleeding). Inappropriate professional delay (misdiagnosis or observation without specific action) occurred in 30 consultations (12.4%) and resulted in a further 1.3-month mean delay in treatment. No correlation (r = 0.027) was found between delay in diagnosis and thickness of melanoma for the study population overall. A significant relationship (r = 0.2087; P less than 0.05) was found between longer lag time and advanced disease in 92 patients with nodular melanoma. Asymptomatic melanomas incidentally diagnosed during routine skin surveillance were significantly more favorable (mean depth, 0.89 mm) than symptomatic melanoma (1.76 mm; P less than 0.01). These data suggest that future public education campaigns should emphasize early signs of melanoma and that professional programs should stress routine skin surveillance and prompt referral of suspicious lesions for diagnostic biopsy.

Adolescent↗
PubMed1991

Evaluation of a commercial kit for detection of Streptococcus pyogenes in a burns unit.

The presence of Streptococcus pyogenes (group A Streptococcus) may increase morbidity in burns patients. A rapid detection system enabling early therapeutic intervention is therefore desirable. A commercial kit (Wellcome Diagnostics Reveal Colour Strep A) was evaluated in a burns unit. Two separate studies were undertaken. The first compared two swabs taken from a particular burn site, one of which was cultured conventionally and the other processed for rapid detection. In the second study, swabs were processed routinely and then subjected to the rapid detection test in order to assess reproducibility of results. In our hands the rapid test was easy to perform and correlated well with conventional culture. We recommend the use of a rapid detection system for S. pyogenes as a useful adjunct to conventional culture methods.

Burn Units↗
PubMed1991

Metabolic response to localized surgical fat removal in nonobese women.

Although suction lipectomy and dermolipectomy are common surgical procedures, the body's response to localized removal of fat and the long-term efficacy of these procedures remain controversial. Seven women who underwent liposuction or abdominoplasty were studied prior to surgery and between one and two months postoperatively. All patients were weight-stable prior to surgery and the reported daily food intake and nutrient composition of the diet did not change. The following parameters were measured: resting oxygen uptake (VO2), glucose-induced increment in VO2, anthropometry, and site-specific fat cell size. Fat samples were taken by needle aspiration from abdominal and femoral regions. Resting energy expenditure and the response to glucose feeding were not significantly different postoperatively. Furthermore, site-specific fat cell size did not change, nor were there any significant differences in the sum of four skinfold thicknesses. These results suggest that energy balance was not altered as a result of localized fat removal in previously weight-stable women. Thus, short-term follow-up suggests that surgical fat removal does not result in a compensatory change in metabolic efficiency or fat cell size and distribution in these weight-stable women. Therefore, this technique may prove effective for body contouring in nonobese women.

Abdomen↗
PubMed1990

A simple method of tattoo removal.

The use of trichloracetic acid in the treatment of decorative tattoos is described. The technique is simple to perform. No anaesthesia or analgesia is required. Complications are uncommon and usually minor. Trichloracetic acid acts by inflicting a chemical burn.

Administration, Cutaneous↗
PubMed1990

Site selection for fat autotransplantation: some observations.

The use of autologous fat for implantation has recently received renewed attention in the plastic surgery literature. Autologous fat reportedly has been used for the treatment of wrinkles and Romberg's disease, and for buttock and breast augmentation. While some measure of success has been achieved, many surgeons report that substantial resorption of fat tissue occurs at the site of implantation. There is lack of unanimity regarding the ideal site for extraction or injection in order to minimize fat resorption. Adipose tissue samples were taken from women undergoing surgical procedures on the abdomen, gluteal-femoral region, and breast. Facial adipose tissue samples from men and women were also analyzed. Adipocytes were isolated chemically and sized microscopically. Activity of the lipogenic enzyme adipose tissue lipoprotein lipase (ATLPL) was measured in frozen samples. Results suggest that femoral site samples are somewhat larger (NS) and have greater lipogenic activity (p less than 0.03) than other sites. In our study, small facial samples had very low or unmeasurable levels of ATLPL activity. Perhaps cell size and lipogenic activity should be considered when selecting tissues for autotransplantation.

Adipose Tissue↗