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Biomedical subjects

David Chang

Publications and source records attributed to David Chang.

42 records · Page 3Linked to original sources
PubMed2002

Intraarterial chemotherapy: the effects on free-tissue transfer.

Multimodal therapy including intraarterial chemotherapy is recognized as state-of-the art therapy for soft-tissue cancer. Multimodal therapy often involves regional limb perfusion followed by sarcoma surgery with reconstruction of the resulting defect. This study was performed in an effort to evaluate the potential of free flap reconstruction after intraarterial therapy. A retrospective chart review of 52 patients who had undergone limb perfusion between 1988 and 1998 at the University of Texas M. D. Anderson Cancer Center and the Division of Plastic Surgery, University of Bochum, Germany, identified 16 patients who had undergone intraarterial limb perfusion that was then followed by surgical resection and free flap reconstruction. There were seven women and nine men, with an average age of 37.9 years. All sixteen patients had received preoperative adjuvant systemic chemotherapy. Reconstruction of the lower extremity was performed most commonly with rectus abdominis and latissimus dorsi free flaps. All vessels used for donor recipient anastomosis had been previously perfused. A vein graft was used in one case. Split-thickness skin grafting over the free flaps was used in four cases. The average length of hospitalization was 21.75 days, with an average follow-up of 20 months. No flap loss or infection was observed. Two flaps demonstrated partial edge necrosis. Three patients developed partial split-thickness skin graft loss and one developed a seroma that required no treatment. A draining sinus tract required resection in one patient. The overall flap success rate was 100 percent, with no flap failures. The overall surgical outcome was considered to be good in 12 patients on the basis of improved function and ambulation, and fair in four who had limitations in function and/or ambulation on the basis of both the patient self-evaluation and the physical therapy evaluation. Seven patients had recurrence of their disease. The overall mean survival time after surgery was 20.6 months. Currently, 10 patients are alive and six have died from their disease. The results of this study indicate that preoperative intraarterial chemotherapy does not significantly increase the risk of immediate free flap complications. Although our numbers are small, we believe that there is no clinical evidence justifying hesitation or refusal of free flap reconstruction after limb perfusion and intraarterial chemotherapy. Routine care in vessel selection and microsurgical technique should be performed to maximize favorable outcomes. Vessels should be inspected for their suitability before undertaking any free flap reconstruction.

Adult↗
PubMed2002

Compliance with sequential compression device prophylaxis in at-risk trauma patients: a prospective analysis.

The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD prophylaxis among nonambulatory trauma patients at risk for DVT. We conducted a prospective observational study at two Level I university-affiliated trauma centers. Nonambulatory trauma patients were observed during their early postadmission period in a non-critical care setting. Six observations were made as to proper SCD applications during a 24-hour period (two times in the morning shift, two in the evening shift, and two overnight). "Full compliance" was defined as SCD on and functioning properly in all six observations. In a total of 1343 observations in 227 patients only 42 patients (19%) were fully compliant. The devices were on and functioning in 712 (53%) observations. Among the 185 patients who were not fully compliant DVT risk factors were common (83%) and adjunctive heparin prophylaxis was infrequent (27%). The most common times for "noncompliant" observations were early afternoon and midmorning. On multivariate analysis only spinal column injury correlated with increased compliance. In nearly half of the observations trauma patients at risk for DVT were not receiving their SCD prophylaxis as per physician orders. Fewer than 20 per cent of patients had the devices on and functioning during each of the six observations during a 24-hour period. These data point to the need for education of hospital staff and for additional prophylactic measures in at-risk patients.

Adult↗
PubMedDate not supplied

Results of curative therapy for esophageal cancer in a community training hospital.

A 12-year experience of therapy for esophageal carcinoma in a community-based cancer center was reviewed retrospectively. Of a total of 88 patients with histologically proven carcinoma of the esophagus 30 (34.1%) underwent curative esophagectomy. Twelve patients received preoperative chemoradiotherapy. Fourteen esophagectomies were performed transhiatally and 16 via the thoracolaparotomy approach. The average distance from incisors was 32.2 and 32.1 cm, respectively. Overall morbidity was 36.7%, with major complications in 30% of patients. Mortality was 3.3%. A comparison of patients treated with preoperative chemoradiotherapy (12 patients) and surgery alone (18 patients) showed no statistical difference in morbidity, mortality, or length of hospital stay. Analysis of these parameters in groups of patients operated via the transhiatal versus thoracolaparotomy approach demonstrated statistically lower morbidity (14.3% versus 56.3%, respectively), with no difference in mortality and a trend toward a shorter hospital stay in the former group. Overall survival at 3 years was 63.9%. In the combined therapy group, 90.9% of patients survived 3 years compared to 40.4% in the surgery only group (P = 0.0177). There was a trend toward better survival in the group of patients treated via the transhiatal approach. This study demonstrated that curative therapy for esophageal carcinoma can be performed with acceptable morbidity and mortality in a community teaching hospital.

Adenocarcinoma↗
PubMedDate not supplied

Prevention of intraperitoneal adhesions by intraperitoneal lavage and intraperitoneal 5-fluorouracil: experimental studies.

Postoperative adhesions remain the leading cause of small bowel obstruction. Peritoneal adhesions were induced in 180 rats by scraping the cecum and burning the adjacent parietal peritoneum by electrocoagulation. The adhesions were scored 14 days later in a blinded manner. All four types of intraperitoneal instillations significantly reduced the extension and the severity of the adhesions, at both schedules, when compared to the control group. The use of 5-fluorouracil at 20 mg/kg in peritoneal dialysis solution during 5 days significantly decreased the global score (P = 0.04), the extension (P = 0.04), and the severity (P = 0.04) of adhesions when compared to the 5-day instillation of peritoneal dialysis alone. Lavage of the abdomen with peritoneal dialysis solution or hetastarch decreased the formation of adhesions. Instillation of 5-fluorouracil in a large volume of peritoneal dialysis solution could be novel and promising treatments for prevention of postoperative adhesions.

Animals↗
PubMedDate not supplied

Biomechanical comparison of five external wrist fixators.

The relative stiffness of five different external wrist fixators currently in use for distal radius fractures was determined using a uniform fracture model consisting of wood dowels to isolate the effects of the fixators themselves. Each construct was loaded in axial compression, eccentric and cantilever modes of bending, and torsion. The stiffest of the fixators varied by a factor of three in compression, five in bending, and three in torsion. Although the ideal stiffness of a wrist fixator is unknown, there is a large variation in the stiffness of existing devices.

Biomechanical Phenomena↗