PubMed Health⌕ Search

Biomedical subjects

G Georgiade

Publications and source records attributed to G Georgiade.

18 recordsLinked to original sources
PubMed1999

Comparison of omental and pectoralis flaps for poststernotomy mediastinitis.

BACKGROUND: Pectoralis flaps are frequently used to treat poststernotomy mediastinitis. We compared the outcomes of omental transfer, an alternative treatment for mediastinitis, with those of pectoralis flaps. METHODS: Patients treated for poststernotomy mediastinitis with isolated omental flaps (n = 21) were compared with a group of consecutive patients treated with pectoralis flaps (n = 38). Baseline characteristics were equivalent for the two groups, and both early and late outcomes were compared. RESULTS: Length of procedure and length of postoperative hospitalization were reduced significantly and there were significantly fewer early complications in the group treated with omental flaps. Furthermore, there were no early or late flap failures or abscesses in the omental flap group. CONCLUSIONS: This study found that omental flaps had improved early outcomes and are a more effective therapy relative to pectoralis flaps for poststernotomy mediastinitis. Technical considerations for omental transfer that could optimize results are given.

Aged↗
PubMed1998

Management and prevention of cardiovascular hemorrhage associated with mediastinitis.

OBJECTIVE: To elucidate the causes of cardiovascular hemorrhage associated with mediastinitis and to review recommendations for prevention and treatment. SUMMARY BACKGROUND DATA: Mediastinal debridement with immediate or early coverage using healthy, vascularized tissue has lead to greatly reduced morbidity and mortality for patients with mediastinitis. Myocardial hemorrhage has been anecdotally reported. PATIENTS AND METHODS: Over a 36-month period, 7 patients developed massive cardiovascular bleeding after undergoing debridement for poststernotomy mediastinitis. Causes included puncture or erosion by a sternal edge in three and tearing at the myocardial-sternal interface in four. RESULTS: Five patients survived and remain infection-free at an average of 24 months of follow-up. In these patients, ventricular defects were closed with pledgeted sutures and muscle transposition was used concomitantly to reinforce the repair. This involved a slide of the left pectoralis major muscle and turnover of the right pectoralis in three patients, bilateral sliding in one patient, and bilateral pectoralis and an omental flap in one patient who required additional coverage of the lower mediastinum. CONCLUSIONS: When a patient who has undergone mediastinal debridement shows evidence of significant bleeding, we recommend application of pressure for control of hemorrhage, expeditious return to an operating room with available cardiopulmonary bypass, and immediate muscle coverage with healthy, well-vascularized tissue. Finally, early sternectomy might largely prevent this life-threatening complication.

Aged↗
PubMed1996

Factors contributing to patient satisfaction with breast reconstruction using silicone gel implants.

Recently, concerns have been raised about risks and benefits of silicone gel implants for breast reconstruction. Using a survey conducted during the silicone controversy that began in 1990, this study examines patient satisfaction in 174 women with silicone breast implants. Overall satisfaction was high; 43 percent indicated complete satisfaction, and only 3 percent stated they were "not at all" satisfied. Satisfaction was correlated with each woman's assessment of how reconstruction met her expectations, particularly expectations about clothes fitting better, feeling whole, looking normal, and having similar-appearing breasts. Higher levels of satisfaction also were associated with lower body mass index and absence of medical problems. While patients appeared satisfied with their reconstructions, 34 percent said they would be completely unlikely to choose silicone implants today. Further research is needed to understand the impact of the silicone breast implant debate on women who have had or may consider breast reconstruction.

Adult↗
PubMed1993

Silicone controversy: a survey of women with breast cancer and silicone implants.

BACKGROUND: During the past 3 years, there has been a highly publicized debate concerning the potential medical complications of silicone breast implants. There have been no studies that have addressed the effect of this controversy on women with a history of breast cancer who have undergone breast reconstruction with silicone implants. PURPOSE: This study was undertaken to understand the concerns of such women regarding their breast reconstructions and to assess what impact the silicone implant controversy had on them. METHODS: One hundred seventy-four randomly selected women who had undergone reconstructive surgery with silicone implants subsequent to mastectomy for treatment of breast cancer were interviewed by telephone from February through May 1992. (A moratorium on use of silicone breast implants, imposed by the Food and Drug Administration, extended from January through April 1992.) These women, a subset of 359 mastectomy/reconstruction patients of one university-based plastic surgeon, had their first permanent prostheses placed between 1985 and 1990. The interview included questions designed to elicit information about women's experiences with reconstruction and reactions to the controversy. RESULTS: All study participants were aware of the controversy surrounding silicone implants. Seventy-six percent stated that breast reconstruction helped them cope with cancer, and only 16% had regrets about reconstruction. Many respondents had misconceptions about the nature of possible complications from silicone implants. Fifty-five percent were worried about the implants, yet only 13% considered having them removed as a result of the controversy. Only 27% indicated they would be completely likely to choose silicone implants again. The majority of women were unwilling to accept substantial risks of complications from implants, but there was variability in the level of risk that respondents would tolerate. CONCLUSIONS: A majority of women who have had breast reconstruction using silicone implants after treatment of breast cancer believe that implants helped them cope with the cancer. However, a sizeable proportion of such women are worried about possible medical complications that may develop as a consequence of silicone breast implants. Many would likely not choose these implants today. IMPLICATIONS: The true risks associated with silicone implants will ultimately be known. In the meantime, health care providers need to address patients' concerns about these implants. Information and guidance regarding the potential benefits and risks of breast implant devices should be provided to women with breast cancer who are considering treatment options.

Adult↗
PubMed1990

Long-term prognostic implications of sex-steroid receptors in human cancer.

Progesterone receptor analysis has been used to enhance the prognostic usefulness of estrogen receptor analysis in breast cancer. Immunocytochemical assays for both steroid receptors have been shown to correlate with established biochemical techniques but lack long term clinical follow-up studies to validate their use. One hundred fifty- two patients were followed for up to 10 years after primary surgical treatment. Steroid receptor analyses, using both biochemical and immunocytochemical techniques were performed on their tumor specimens. Patients with estrogen or progesterone receptor positive tumors had longer survival than patients with negative tumors. This difference was most clearly demonstrated with immunocytochemical analysis of estrogen receptors (p = 0.04). The two methods for progesterone receptors gave very similar results. Use of multivariate analysis revealed that ER by immunocytochemical analysis was the only significant predictor of prognosis when all four variables were considered simultaneously (p = 0.04). This study suggests that immunocytochemistry gives comparable results to biochemical analysis for progesterone receptors but that immunocytochemical analysis of estrogen receptors was the stronger single prognostic indicator of the four.

Breast Neoplasms↗
PubMed1989

Preoperative positioning of the protruding premaxilla in the bilateral cleft lip patient.

The rationale and technique for preoperative retraction of a protrusive premaxilla in the bilateral complete cleft lip and palate patient are presented. Two types of pinned intraoral appliances are presented that can expand the palatal shelves while retracting the premaxillary segment. Findings from lateral cephalometric x-ray studies of eight appliance patients and six control patients with bilateral clefts but no appliance treatment are presented at age 15. The data indicate that the cephalometric values at age 15 are within the normal range for most patients. Incisor angulation was quite varied among the subjects.

Adolescent↗
PubMed1986

Skin coverage in occupational hand injuries.

Intact skin is vital after occupational hand injuries. The best bone, tendon, and neurovascular repairs are meaningless without suitable skin coverage to protect them. This article presents various methods of providing skin coverage in the hand after occupational injuries and follows the same thought process that surgeons should use in selecting the most appropriate method of repair.

Dermatologic Surgical Procedures↗
PubMed1985

Efficacy of povidone-iodine in pre-operative skin preparation.

Cultures were obtained of the microbial flora from the skin of the operation site pre-operatively and following preparation of the surgical field with povidone-iodine (PVP-I). Preliminary results indicate that PVP-I is a reasonable and effective antibacterial agent when used to prepare skin for surgical operations.

Adolescent↗
PubMed1985

A flap for moderate-sized oral defects.

The use of a cervical musculocutaneous flap is described which is easily transferable to the oral cavity to cover an osseous and soft tissue operative defect, eliminating the need for a more distant and extensive musculocutaneous flap.

Aged↗
PubMed1984

Clinical response to hormone therapy correlated with estrogen receptor analyses. Biochemical v histochemical methods.

Estrogen receptor (ER) analysis by sucrose density gradient analysis (SDGA) was compared with histochemical localization of estrogen binding using 6-carbomethoxy-bovine serum albumin-fluorescein isothiocyanode-estradiol (E2-6-CMO-BSA-FITC) (6FE), 17-thiosemicarbozene-BSA-FITC-estrogen (E-17-TSC-BSA-FITC) (17FE), and polyestradiol phosphate-antiestradiol antibody-FITC (PEP) on serial frozen sections of metastatic breast cancer lesions from 72 patients treated with hormonal therapy. A comparison of assays to clinical responses gave the following sensitivities: ER-SDGA, 90%; 6FE, 50%; 17FE, 55%; and PEP, 58%. Specificities were as follows: ER-SDGA, 81%; 6FE, 47%; 17FE, 41%; and PEP, 59%. The SDGA gave the highest predictive value for clinical response, while the predictive value for each of the three histologic techniques approximated that predicted by chance alone. These selected histochemical techniques for ER localization, despite impressive cytologic localization patterns, therefore, do not correlate with clinical response.

Antibodies↗
PubMed1982

Rationale for immediate reconstruction of the breast following modified radical mastectomy.

In 62 patients in whom modified radical mastectomy was accompanied by immediate breast reconstruction, the operative and pathologic findings are compared to the clinical results. Immediate reconstruction following modified radical mastectomy appears to offer several advantages over delayed reconstruction. The data indicate that immediate reconstruction provides excellent technical results, is associated with less expense and morbidity as compared to delayed reconstruction, and does not adversely affect the natural course of the disease within the follow-up period studied. No adverse effect of adjuvant chemotherapy on the reconstructive effect was noted in this series of 62 patients when the initiation of adjuvant chemotherapy was timed so as to avoid difficulties with hemostasis. The technical aspects of the immediate reconstruction are described.

Adult↗
PubMed1981

A silent but lethal injury associated with facial trauma.

Without a careful evaluation of all patients with major facial injuries and a thorough search for possible associated injuries, traumatic transection of the aorta may be easily missed, if the patient survives the first 24 hours after injury. Any patient subjected to sudden deceleration injury, particularly following automobile or motorcycle accidents, should be evaluated carefully for traumatic aortic rupture. Patients with associated chest trauma should have chest x-rays in the emergency room, and repeat chest films several hours later should be obtained to identify subsequent development of a widening mediastinum. Proper management of possible aortic transection should include arteriograms when appropriate and prompt surgical intervention when indicated. All patients with major injuries should be thoroughly evaluated by a trauma team so that associated injuries may be quickly recognized and treated.

Accidents, Traffic↗
PubMed1980

Use of skin staples in plastic surgery.

Skin closure with stainless steel staples can be done economically, simply, quickly, and accurately. Stapling is indicated in a wide range of surgical procedures. Scarring is minimal and patient acceptance is excellent.

Dermatologic Surgical Procedures↗
PubMed1979

Reduction mammaplasty utilizing an inferior pedicle nipple-areolar flap.

A technique utilizing the inferiorly based dermal pedicle nipple-areolar flap is described. The advantages of this technique are:(1) predictable breast shape based on preoperative markings; (2) direct visibility of all areas for ease of resection and hemostasis; (3) retention of normal nipple duct connections; (4) no impairment of subjective sensation; and (5) adequate blood supply. This technique has particular application in younger women, in whom nipple sensation is quite important. The interruption of the intercostal nerve branches is usually limited because of the thickness and width of the inferior pedicles. Utilizing our modifications of the technique originally described, this versatile flap can now be used routinely in reduction mammaplasties requiring the removal of either small amounts (200 gm) or quite large amounts (2,500 gm) of tissue with consistently satisfactory aesthetic results and excellent patient satisfaction.

Adult↗