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Biomedical subjects

D T Netscher

Publications and source records attributed to D T Netscher.

At least 37 records · Page 2Linked to original sources
PubMed1996

Diagnostic value of clinical examination and various imaging techniques for breast implant rupture as determined in 81 patients having implant removal.

To determine sensitivity and specificity of magnetic resonance imaging (MRI) and ultrasonography (US) in the detection of breast implant rupture, and also to determine the relative merits of clinical examination and mammography, we studied 81 patients (160 implants). All patients had implants removed, thus allowing confirmation of the presence or absence of rupture. Clinical examination positively identified only one patient with implant rupture, and mammography detected only two implant ruptures (both extracapsular). The sensitivity for US was 70% and specificity was 90%, while for MRI it was 75.6% and 94%, respectively. These differences between MRI and US were not statistically significant. Combining the results of US and MRI did not seem to add to the diagnostic discrimination. The most cost-effective method of diagnosing implant rupture was US in our study.

Adult↗
PubMed1996

Massive asymmetric virginal breast hypertrophy.

Massive unilateral virginal breast hypertrophy in a 13-year-old girl was treated by right breast reduction, with removal of 2,968 g of breast tissue. A year later, the patient had enlargement of the left breast, and contralateral reduction mammoplasty was done. Two-year follow-up has shown no further enlargement. This case lends itself to a discussion with regard to the differential diagnosis of unilateral breast hypertrophy in adolescence. True virginal gigantomastia is relatively rare. Surgical reduction mammoplasty plays a pivotal role in the treatment of massive virginal breast hypertrophy.

Adolescent↗
PubMed1996

Adult-type colloid milium of hands and face successfully treated with dermabrasion.

Colloid milium is an unusual cutaneous disorder characterized by multiple cystic papules. The adult form develops in sun-exposed parts of the body in patients who have actinic-damaged skin. We describe the case of a patient with the classic clinical and histologic features of this disorder. The patient was successfully treated by dermabrasion to the hands and affected facial regions and, 10 months later, has not shown any signs of recurrence.

Amyloid↗
PubMed1996

Superficial versus deep: options in venous drainage of the radial forearm free flap.

We performed a fresh cadaver dissection study of the superficial venous system (cephalic vein and its branches) and the deep venous system (venae comitantes) of the radial forearm to assess the suitability of each system for venous anastomosis during free tissue transfer. We used methyl methacrylate to evaluate vessel diameters and anatomic variability of both venous systems. Colored radiopaque injectate allowed us to combine anatomic dissection with tissue radiographs. We discovered the cephalic vein to invariably be of larger caliber than the venae comitantes. Ensuring capture of the cephalic vein in the flap necessitated additional dorsoradial subcutaneous dissection beyond the boundaries of the skin flap in four of ten specimens. The vessel diameters of the venae comitantes in four cadavers were less than 2 mm. Proximal confluence of the two venae comitantes, and communication between the deep and superficial venous systems were encountered in only four cases. In these cases, had an anastomotic site been chosen proximal to such a communication to ensure greater vessel caliber, pedicle length probably would have made free tissue transfer unwieldy. We recommend mapping the course of the cephalic vein before flap elevation and maintaining a wide proximal subcutaneous pedicle to capture the best possible superficial drainage system. If the superficial venous system has been damaged (as by previous intravenous catheterization), one may not necessarily be able to rely on the vessel caliber of the deep venae comitantes for microvenous anastomosis.

Brachial Artery↗
PubMed1995

Functional results of dynamic splinting after transmetacarpal, wrist, and distal forearm replantation.

The results of replantation at the wrist and distal forearm are reported to be better than at the metacarpal level, in part because the latter involve direct injury to the intrinsic muscles. This study evaluates a new post-operative protocol for replantation at the metacarpal, wrist and distal forearm levels. 3 days after replantation, the patient was placed in a dynamic crane outrigger splint with MP joint control, compensating for intrinsic muscle function loss. From 4 to 12 weeks, an anticlaw splint alternated with the outrigger splint. After 12 weeks, a dynamic wrist extension orthosis was added to the anti-claw splint. 11 patients (four replantations at the transmetacarpal level, three at the wrist and four in the distal forearm) had this protocol between 1988 and 1993. For distal forearm replantation, TAM of fingers averaged 216 degrees, grip strength 42 lb, and pinch strength 7.2 lb with 75% good or excellent results. For wrist replantations, TAM of fingers averaged 243 degrees, grip strength 37 lb and pinch strength 10.6 lb with 100% good or excellent results. For transmetacarpal replantations, TAM of fingers averaged 189 degrees, grip strength 37 lb and pinch strength 5.6 lb, with 75% good and excellent results. Early protected mobilization, as described here, preserves tendon gliding, muscle strength and excursion. Our results support this protocol for wrist and distal forearm replantation and especially for transmetacarpal replantation, the results of which tend to be poor according to the medical literature.

Adult↗
PubMed1995

Vasoactive effects of smoking as mediated through nicotinic stimulation of sympathetic nerve fibers.

Patients who smoke have higher complication rates than nonsmokers following many surgical procedures. It is not known if the adverse effects of smoking are caused by a nicotine effect or by some other potentially harmful agents that exist in tobacco smoke. It is also not known if these vasoactive effects are mediated through sympathetic nerve fibers (via nicotinic receptors in ganglia) or through elevated circulating levels of vasoactive hormones. We designed a 5-day protocol to measure relative blood flow both before and after a digital sympathetic block in the digits of subjects who were regular smokers following both smoking and wearing of a transdermal nicotine patch. Suitable pulse/wave tracings were recorded on 23 subjects. We also measured serum levels of nicotine, cotinine, vasopressin, norepinephrine, epinephrine, dopamine, and carboxyhemoglobin on each test day. Data for these serum levels were available in 30 test subjects. Digital sympathetic block had a significant beneficial effect in reversing the decreased digital blood flow that occurred after smoking (and also with use of the nicotine patch), despite the elevated circulating levels of vasopressin and norepinephrine seen with smoking. The vasoactive effects of smoking are probably due to the nicotinic effects on sympathetic fibers at the ganglionic levels.

Adult↗
PubMed1995

Utility of magnetic resonance imaging and ultrasonography in diagnosing breast implant rupture.

We prospectively evaluated 81 patients (with 160 implants) who subsequently had implants removed to determine sensitivity and specificity of both magnetic resonance imaging and ultrasonography. Positive and negative predictive values were also calculated to determine whether a statistically beneficial interaction existed when ultrasonography and magnetic resonance imaging were used in combination to examine an implant. Finally, the misdiagnoses were retrospectively evaluated to identify the pitfalls of the investigations. Positive diagnostic criteria were described. The sensitivity and specificity of ultrasonography were 47% and 83%, respectively, and of MRI, 46% and 88%, respectively. On retrospective review by the radiologist, the sensitivity and specificity of ultrasonography were 70% and 90%, respectively, and of magnetic resonance imaging, 75.6% and 94%, respectively. Although definite conclusions could not be obtained, there did not seem to be an additive benefit from using both ultrasonography and magnetic resonance imaging.

Breast↗
PubMed1995

The hemodynamic and hematologic effects of cigarette smoking versus a nicotine patch.

Patients who smoke have higher complication rates than nonsmokers in the postoperative period. The authors designed an experimental protocol for habitual smokers (n = 30) to determine the specific hemodynamic and hematologic adverse effects possibly caused by nicotine and whether the method of nicotine delivery and systemic nicotine levels achieved might influence these adverse effects. During the 5-day study, subjects were asked to refrain from smoking, and testing sessions were conducted as follows: on day 1, the subjects smoked two cigarettes immediately before testing; on day 3 (control day), testing was done after not smoking for 48 hours and then the subjects were instructed to wear a transdermal nicotine patch (PROSTEP 22 mg/day) for 24 hours and replace it with another so that, on day 5, testing took place after the subjects had worn the patch for approximately 34 hours. At each testing session, digital artery pulse amplitude and a number of clinical and serum blood level parameters were measured. Relative digital blood flow after smoking (69.2 +/- 5.8%) and with the patch (80.4 +/- 7.6%) was lower than on the control day (100.0 +/- 0.0%). The nicotine patch, unlike smoking, had no effect on vasopressin or fibrinogen concentrations, hematocrit, or white cell or platelet counts; both smoking and the patch resulted in elevated norepinephrine levels.

Administration, Cutaneous↗
PubMed1995

Transconjunctival versus transcutaneous lower eyelid blepharoplasty: a prospective study.

Debate continues over the relative merits of transconjunctival and the more customary subciliary transcutaneous approaches for lower lid blepharoplasty. Ten consecutive patients presented for blepharoplasty, and in all patients the transcutaneous subciliary musculocutaneous flap approach was used on the left lower eyelid and the transconjunctival preseptal approach was used on the right. Patients served as their own controls. Follow-up was evaluated clinically by patient questionnaire and by standardized photographs preoperatively and at 5 days, 1 month, 3 months, and 6 months postoperatively. Photographs were graded independently by four blinded examiners. No statistical difference was identified in measured fornix depth between preoperative patients and postoperatively on each side. Average fat removed from each side was the same, and no patient had an identified "missed fat compartment." Three patients had mild bilateral scleral show postoperatively, and a fourth developed it on the left (transcutaneous) side. However, overall grading on both sides was universally very good with no significant difference on the two sides--0.68 on the right and 0.60 on the left (maximum worst grade could be 5.0 and best grade 0). The potential for external scarring was never a perceived problem in the transcutaneous technique.

Adult↗
PubMed1995

Clinical relevance of positive breast periprosthetic cultures without overt infection.

The true incidence of positive breast periprosthetic cultures in the absence of overt infection is not clearly established. We retrospectively reviewed data from 389 implants that were removed for reasons other than clinical infection. Many of these patients presented with a variety of musculoskeletal ailments. Others had symptomatic capsular contracture as the presenting complaint. In a few a known implant rupture was the reason for explantation. We identified a positive culture rate of 23.5 percent from capsule tissue. Most of these organisms were coagulase-negative staphylococci and anaerobic diphtheroids, but fungi and other organisms (generally felt to be more pathogenic than the less virulent coagulase-negative staphylococci) also were cultured. In an attempt to identify the clinical relevance of these positive cultures, we statistically evaluated the culture results for associations with capsular contracture, implant rupture, type of implant, and location of implant. Of these, the only statistically significant correlation was between positive culture result and symptomatic capsular contracture (Baker class IV).

Adult↗
PubMed1995

A review of 198 patients (389 implants) who had breast implants removed.

Because of the large number of women now returning to their plastic surgeons with concerns about their breast implants many years after surgery, we are afforded an ideal opportunity to evaluate these patients over the long-term. This study reviewed 198 patients (389 implants) who underwent explantation by two surgeons over a 2-year period, correlating prosthesis type, location, and length of time since implantation with two adverse endpoints, implant rupture and symptomatic capsular contracture. Significant findings included a relatively high rate of implant rupture in patients whose implants had been in place over 20 years, an increased incidence of both symptomatic capsular contracture and implant rupture in single lumen gel implants and a positive correlation between severity of capsular contracture and implant rupture.

Adult↗
PubMed1995

Generalized elastolysis (cutis laxa): case study illustrating associated medical and surgical conditions.

Cutis laxa is grouped with the other hyperelastic skin conditions, but it shows almost total lack of skin elasticity. Numerous other medical and surgical conditions may coexist with the skin problem, since it is a generalized affliction of the supporting connective tissues. Our patient had cutis laxa proved by skin biopsy. All surgical procedures were done without any wound complications. He had many associated medical conditions and so served as an excellent opportunity to review the condition of cutis laxa.

Aged↗
PubMed1994

Basal cell carcinoma of the scalp resulting in spine metastasis in a black patient.

Basal cell carcinoma (BCC), the most common skin cancer in the United States, is locally invasive but has a low risk of metastasis. BCC is rare in black patients but, regardless of racial origin, most BCC occurs on sun-exposed areas. We describe a 67-year-old black man with a large BCC on the hairy scalp, a relatively sun-protected area, that metastasized to the spine. To our knowledge, this is the first description of a black patient with development of metastatic BCC on an otherwise normal scalp.

Aged↗