Biomedical subjects
Publications and source records attributed to E Freedlander.
A group of 41 patients were questioned about functional problems and concern for appearance, experienced following major surgery for intraoral malignancy. Twenty-five per cent of the group reported significant difficulties. Spouses reported a higher incidence of problems. The effects of primary tumour site and type of reconstruction on functional outcome are discussed.
A cohort of patients who had received major intra-oral surgery, up to 10 yr (mean 3.5 yr) prior to this study were reviewed and assessed for evidence of current psychological disturbance. Forty-one per cent of patients were found to have significant levels of psychological distress comprising mood disorder, social dysfunction or both types of difficulty. Prevalence of clinical anxiety and depression per se was within the range 22-32%, but few patients were receiving any form of active therapy for these problems. Investigation of predictors revealed that females and younger people were more at risk to psychological distress. Tentative evidence for variability in psychological outcome in relation to tumour site is also reported. Results are discussed with reference to service provision needs and further research priorities.
The fate of buccal mucosal flaps used in 50 cases at the time of primary palatal repair is reviewed. It was found that in 13 cases (26 percent) the pedicle of the flap interfered with the eruption of the permanent molars and had to be divided. Nasendoscopic examination was made of the palate in 16 cases in an attempt to visualize the buccal flap. It was identified in only three cases. It is suggested that if this flap is to be used, it must be designed carefully, and that regular intraoral examination of the patients is required around the time of eruption of the permanent molars.
A case is reported of brachial plexus cord compression resulting from an island pedicle latissimus dorsi musculocutaneous flap used to resurface a facial defect.
Twenty-one patients with replanted digits were examined. An assessment of cold symptoms relating to their replants was made and the pulp two-point discrimination measured. Cutaneous blood flow was then monitored using a laser Doppler flowmeter. Recordings were taken at room temperature and following cooling. In all cases but one flow decreased with lowering of temperature in both replanted and normal digits. In eleven cases (52%) replant flow fell to noticeably lower levels compared to normal digits, but in the remainder this difference was not apparent. The presence or absence of cold intolerance did not correlate with flow levels or with two-point discrimination measurements.
Explore the source record for details and available documents.
A number of cases of squamous carcinoma of the pinna were examined. The rate and pattern of metastases were established and a review of the histology carried out. No histological parameters could be identified at the initial resection that were useful in predicting the likelihood of metastases. The importance of adequate initial surgery is emphasised.
The pectoralis major myocutaneous island flap is useful for axillary reconstruction following resection of tumour and skin in the axilla. It is a useful alternative to the latissimus dorsi flap, particularly when the vascular pedicle of the latissimus dorsi muscle is infiltrated by tumour or has been sacrificed by previous surgery.
A long term review has been carried out to assess the results of intra-oral split-skin grafts in the closure of defects produced by the excision of intra-oral, predominantly malignant, lesions. The technique of grafting, the quality of the final result and the possibly disabling complications are related in great part to the site of the original lesion and the extent of the surgical excision required.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Evidence that oxygen free radicals may be contributory to further tissue damage in the events following cutaneous thermal injury supports a role for interventional therapy using antioxidants. However, previous work has relied almost entirely on animal-based models with little clinical information available. Also, methods used to support an oxidative role in thermal injury have relied almost exclusively upon the use of lipid peroxidation studies. Further work substantiating a contributory role of free radicals is therefore required using additional methodology before considering antioxidant therapy aimed at retarding tissue damage. We investigated general oxidative damage to protein in burn blister fluid by quantifying the protein carbonyl levels from 11 patients admitted with superficial or partial thickness burns. Total antioxidant capacity was also assessed, together with measurement of protein and the antioxidants uric acid and bilirubin. Data were compared with values obtained for serum in healthy volunteers. Following thermal injury, burn blister fluid protein carbonyl level was increased by almost 50 per cent (P = 0.005) compared with normal serum. Antioxidant scavenging capacity, protein and bilirubin were all significantly reduced, but uric acid unaltered compared with control values. The present data support a role for oxidative damage in cutaneous thermal injury.
We have previously reported that reconstructed human skin, using deepidermized acellular sterilized dermis and allogeneic keratinocytes and fibroblasts, significantly contracts in vitro. Contracture of split skin grafts in burns injuries remains a serious problem and this in vitro model provides an opportunity to study keratinocyte/mesenchymal cell interactions and cell interactions with extracted normal human dermis. The aim of this study was to investigate the nature of this in vitro contraction and explore several approaches to prevent or reduce contraction. Three different methodologies for sterilization of the dermal matrix were examined: glycerol, ethylene oxide and a combination of glycerol and ethylene oxide. While the nature of the sterilization technique influenced the extent of contraction and thinner dermal matrices contracted proportionately more than thicker matrices, in all cases contraction was driven by the keratinocytes with relatively little influence from the fibroblasts. The contraction of the underlying dermis did not represent any change in tissue mass but rather a reorganization of the dermis which was rapidly reversed (within minutes) when the epidermal layer was removed. Pharmacological approaches to block contraction showed forskolin and mannose-6-phosphate to be ineffective and ascorbic acid-2-phosphate to exacerbate contraction. However, Galardin, a matrix metalloproteinase inhibitor and keratinocyte conditioned media, both inhibited contraction.
It is unclear whether burn blister fluid is beneficial or deleterious to the healing of the underlying wound. We investigated the calcium binding protein calmodulin in human burn blister fluid and its role in the mitogenicity of this fluid in the culture of human keratinocytes, fibroblasts, and mouse 3T3 fibroblasts. Calmodulin levels in blister fluid were three times greater than in serum (p < 0.005), whereas epidermal growth factor and platelet-derived growth factor concentrations were significantly lower (p < 0.001). Calmodulin in blister fluid was biochemically identified after affinity chromatography, Western blotting, and immunostaining with a monoclonal antibody. Inhibiting calmodulin with either an antagonist or antibody to calmodulin reduced the mitogenic activity of blister fluid in three cell types by 26% to 80%. These in vitro studies suggest that burn blister fluid may promote wound healing, and locally released calmodulin contributes to this effect. In appropriate cases it may be beneficial to leave burn blisters intact.
This study investigated the effect of short-term storage on the viability and in vitro attachment efficiency of cultured epithelial autograft sheets. Four storage protocols were investigated: overnight at 37 degrees C in keratinocyte culture medium, overnight at 4 degrees C in phosphate-buffered saline solution, overnight at -80 degrees C in cryopreservation medium (containing 10% dimethyl sulphoxide), and 1 week at -80 degrees C in cryopreservation medium. Viability was assessed before and after storage by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay. All the storage conditions significantly reduced viability compared with fresh sheets, and no significant decrease was seen when the sheets stored under the different protocols were compared with each other. The best viability obtained was 60% of that of the fresh sheets. The in vitro viability of these stored sheets was then compared with that of the fresh sheets by culturing them on deepidermized acellular allodermis and assessing the composites formed by light microscopy and the MTT assay. The fresh sheets attached and formed a histologically demonstrable composite with the dermal substrate, whereas none of the stored sheets formed demonstrable composites. The MTT assay demonstrated that composites formed with the stored sheets had less than 10% viability compared with composites formed with fresh sheets. It is concluded that under the conditions of storage examined, the viability of cultured epithelial autograft sheets was significantly reduced, but up to 60% of viability could be retained in some cases. However, the subsequent in vitro attachment and proliferation of such preserved sheets on allogeneic deepidermized dermis was poor compared with that of fresh cultured epithelial autograft sheets.