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Biomedical subjects

J Weinzweig

Publications and source records attributed to J Weinzweig.

At least 37 records · Page 2Linked to original sources

Sagittal band reconstruction.

Extensor tendon subluxation at the metacarpophalangeal joint occurs only rarely in patients without rheumatoid arthritis. Almost all reported cases involve disruption of the radial sagittal band with ulnar subluxation of the extensor tendon. A technique of sagittal band reconstruction is described that entails weaving a retrograde segment of extensor tendon upon itself after passing it through the deep transverse metacarpal ligament. Twenty-one sagittal band reconstructions were performed in 16 patients. This series included 18 cases of ulnar subluxation secondary to radial sagittal band disruption and 3 cases of radial subluxation secondary to ulnar sagittal band disruption. Using this technique, pain was eliminated in every case and there has been no recurrence of extensor tendon subluxation.

Adolescent↗

Determination of silicon in breast and capsular tissue from patients with breast implants performed by inductively coupled plasma emission spectroscopy. Comparison with tissue histology.

A method for analysis of silicon in tissue was developed to determine silicon content in breast parenchymal and periprosthetic capsular tissues of patients with silicone or saline implants and to compare levels in tissues from normal (nonaugmented) breasts. It is of interest to determine whether increased silicon content in tissues can be associated with morbidity in patients who have received silicone implants. This manuscript addresses the issues involved in analysis of breast tissue samples for silicon and compares silicon levels with tissue histologic findings and patient morbidity. One hundred sixty tissue samples were obtained for silicon analysis from 72 patients during augmentation, capsulectomy with or without replacement mammoplasty, mastectomy, or biopsy procedures and were frozen in acid-washed polystyrene tubes at 220 degrees C until analysis. Samples were thawed, sectioned to approximately 0.1 g (dry weight), and digested in nitric acid before analysis by inductively coupled plasma emission spectroscopy, monitoring emission intensity at 251.6 nm. Tissue silicon levels (breast parenchymal and periprosthetic capsular tissue) in patients with silicone gel implants were much higher (mean, 9,287 micrograms/g, n = 106) than in patients with saline implants (mean, 196 micrograms/g, n = 37) or nonaugmented breasts (mean, 64 micrograms/g, n = 17). Histologic examination was performed on 54 tissue samples stained with hematoxylin-eosin. Tissue samples were rated as to degree of inflammation and calcification, and amount of giant cells, foamy histiocytes, and vacuoles containing a colorless refractory material. Vacuolization and foamy histiocyte ratings correlated significantly with tissue silicon concentration. No correlations were found between tissue silicon concentration and inflammation, calcification, or giant cell rating. Implant age (number of years an implant was in place before sampling) correlated with capsular tissue silicon concentration in patients with intact implants but not in those with ruptured implants. No difference in tissue silicon concentration was found between patients with or without signs or symptoms of morbidity. Using 0.1 g of tissue, the method was linear to 1,000 micrograms/g, and sensitivity was 3.7 micrograms/g. Precision between runs (mean, 5.1 micrograms/g; coefficient of variance, 13.7%; n = 13) was calculated from multiple analyses of a bovine liver standard (National Bureau of Standards, reference material 1577a). Significant biologic variability (21.4% to 52.5%) was seen in tissues with high silicon levels. Paraffin-embedded, formalin-fixed tissues are not amenable to silicon analysis by this method, because of leaching of silicone from the tissues during preparation. Thus only fresh frozen tissue samples were used.

Age Factors↗

Recurrent giant cell tumor over a 23-year period.

Giant cell tumor recurrence is certainly not an uncommon event. In fact, recurrence rates as high as 50% have been reported. When recurrence does occur, it is usually within several years of the original tumor excision, if not sooner. The present report illustrates the recurrence of such a lesion twice over a 23-year period and serves to remind one that despite all attempts at complete excision, recurrence of giant cell tumor may still occur even decades following the initial resection.

Female↗

The "Tic-Tac-Toe" classification system for mutilating injuries of the hand.

Several classifications of mutilating hand injuries exist in the literature. Unfortunately, each of these provides a categorization that is arbitrarily grouped according to the part of the hand predominantly involved. It is imperative that a comprehensive classification system incorporate the degree and precise location of soft-tissue and/or bony destruction and the vascular integrity in addition to the predominantly involved part of the hand. We therefore devised a new classification system for mutilating injuries of the hand which categorizes them into seven types: (I) dorsal mutilation, (II) palmer mutilation, (III) ulnar mutilation, (IV) radial mutilation, (V) transverse amputations, (VI) degloving injuries, and (VII) combination injuries. These types are subcategorized into three subtypes: (A) soft-tissue loss, (B) bony loss, and (C) combined tissue loss. Vascular integrity is recorded with subscript notation: (0) vascularization intact or (1) devascularization. The hand is then systematically divided into nine numerical zones in "tic-tac-toe" fashion with radial, central, and ulnar columns and proximal, central, and distal rows. The "Tic-Tac-Toe" classification system allows the examining surgeon to describe precisely any mutilating injury of the hand. This system permits accurate assessment of each hand injury by assignment of the appropriate classification type, subtype, vascular status, and zone involvement. Clinical examples illustrate the user-friendliness and practicality of this new classification system.

Adolescent↗

Physical examination of the wrist.

A complete examination of the wrist requires both an accurate history and a thorough understanding of carpal anatomy, biomechanics, and pathology. A thorough examination may necessitate evaluation of the radial and ulnar aspects of the carpus as well as potential extra-articular causes of wrist pain. A carefully obtained history is essential to focus the examination. Our standard approach to the examination of radial wrist pain consists of five maneuvers: (1) ANA, (2) scaphotrapezial trapezoid (STT), (3) DWS, (4) SS, and (5) FET. Additional diagnostic tests, as described, are indicated by ulnar wrist or extra-articular symptomatology. Substitution maneuvers serve to distinguish between actual and fictitious findings on examination.

Humans↗

The natural progression of scaphoid instability.

Wrist injury or repeated wrist sprains probably result in injury to the scapholunate ligament more commonly than previously recognized, which may allow abnormal scaphoid skid under load. This results in a common clinical entity termed DWS. Scaphoid instability is a spectrum condition ranging from minor, asymptomatic findings (seen in 20% of normal adults) through symptomatic findings in patients with normal radiographs to abnormal instability on radiographs, to degenerative change, and, ultimately, to SLAC wrist (see Fig. 1). Appropriate diagnosis and management of each of these wrist disorders are highly dependent upon a keen understanding of normal periscaphoid anatomy as well as the anatomic derangements that occur within the wrist that predispose a given patient to subsequent degenerative changes. With that understanding, the appropriateness of conservative therapy, SL exploration and arthroplasty, ligament repair, triscaphe arthrodesis, or SLAC reconstruction can be readily determined in each case.

Adolescent↗

Silicon analysis of breast and periprosthetic capsular tissue from patients with saline or silicone gel breast implants.

The ubiquitousness of silicon is well known. Recent work has demonstrated measurable baseline levels of silicon in nonaugmented cadavers, subsequent to numerous reports of significant elevations of such levels within patients with silicone breast implants and even more reports alleging a causal relation between silicone gel prostheses and connective-tissue diseases. Despite the lack of scientifically substantiated data that such a relation exists, the calamitous silicone breast implant controversy has ensued. Saline-filled breast implants are constructed with a silicone elastomer envelope that remains in direct contact with periprosthetic capsular tissue following implantation. Although there is no evidence to link saline implants with any disorders, it is important to know if saline breast implants contribute any silicon to human body baseline silicon levels. The present study measured tissue silicon levels in 28 breasts of 16 patients with saline-filled implants to determine if the silicone envelope of these prostheses can contribute to the elevation of such levels. These data were compared with data from 116 breasts of 65 patients with silicone gel-filled prostheses as well as breast tissue from 17 patients (controls) who had never been exposed to either type of implant. Samples of breast tissue and periprosthetic capsular tissue were obtained from patients with both intact and ruptured implants. Silicon levels of breast tissue specimens from patients with saline-filled implants were within the range of the controls if the implants were intact. Silicon levels in periprosthetic capsular tissue from patients with intact saline-filled implants were significantly higher than controls (p < 0.02); however, they were still 100-fold less than capsular tissue levels from patients with intact gel-filled implants. Silicon levels measured in both types of tissue were significantly elevated in patients with silicone gel-filled implants compared with controls (p < 0.01). In the case of ruptured gel implants, breast tissue demonstrated higher silicon levels than did similar specimens from patients with intact implants (p < 0.054); periprosthetic capsular tissue levels also were elevated, although the differences were not statistically significant (p = 0.54). These findings are independent of the implant brand or length of exposure to the particular prosthesis. The finding of elevated levels of silicon in both breast and periprosthetic capsular tissue in patients with silicone gel-filled implants in no way implies or substantiates any claim of a causal relationship between silicone and any reported illnesses.

Adult↗

Current concepts in mandibular reconstruction by microsurgical free flaps.

Restoration of form and function after composite oro mandibular resections, especially those of the symphysis, is one of the greatest challenges facing the reconstructive surgeon. Loss of the anterior mandibular arch results in serious impairment of oral competence, speech, deglutition, and mastication producing th~ striking cosmetic disfigurement characterized by the "Andy Gump" caricature of the 1930s (Fig. l)Y The pathomechanics of this deformity are due to anterior and medial deviation of the lateral mandibular segments by the residual mylohyoid muscles and superior displacement by the medial pterygoid, masseter, and temporalis muscles. In comparison, these deforming forces are relatively absent following lateral mandibulectomy. Prevention of the "Andy Gump" deformity and its sequelae is paramount and often mandates composite replacement of bone, skin and mucosa. Additionally, through-and-through lateral or posterior defects requiring trilaminar replacement of skin, bone and mucosa or long bone gaps crossing the midline with massive soft tissue losses pose formidable reconstructive challenges.

Journal Article↗

A second look at the second-look technique in face lifts.

Hematoma remains a problematic complication of face lift surgery. Sequelae of hematomas may include temporary skin irregularities, a prolonged postoperative recovery period, skin necrosis, and a compromised final result. Attempts to maximize intraoperative and postoperative hemostasis and thus prevent postoperative hematoma formation have focused on the use of local anesthetics with epinephrine modifications, topical thrombin, bed rest, blood pressure control, local anesthetics with intravenous sedation rather than general anesthesia, and the use of the "second-look" technique popularized 30 years ago. When initially practiced by the senior author, the second-look technique resulted in a dramatic decrease in the incidence of hematoma formation from 21.7 to 6.7 percent. It was concluded at that time that the second-look technique was responsible for the reduced incidence of this face lift complication. However, the present series of 82 face lifts performed using a modification of the original Marcaine/epinephrine infiltration technique without the second-look technique demonstrates an overall incidence of hematoma formation of 7.3 percent. These results demonstrate no advantage of the second-look technique over the traditional technique when epinephrine is infiltrated in the fashion described and meticulous hemostasis is obtained.

Adult↗

Diastematomyelia: a congenital anomaly not to be confused with a giant hairy nevus.

The role of the plastic surgeon in the diagnosis and management of congenital anomalies is often a complicated one that involves the integration of input from numerous specialists into the evaluation process. Diastematomyelia is a serious neurosurgical problem that often presents with cutaneous findings in a neurologically asymptomatic patient. Early recognition of these cutaneous manifestations by the plastic surgeon, evaluation with an MRI scan, and consultation with a pediatric neurosurgeon can prevent delayed diagnosis of this surgically correctable anomaly and irreversible neurologic sequelae.

Adolescent↗

Toxic shock syndrome associated with use of Biobrane in a scald burn victim.

Biobrane remains an excellent biosynthetic dressing for thermal injury coverage. The present report of a probable case of toxic shock syndrome associated with its use does not question its efficacy as temporary coverage for partial thickness thermal burns. Instead, attention is focused on raising the index of suspicion of toxic shock syndrome in burn patients treated with Biobrane, or other occlusive dressings, who develop early signs or symptoms which may be consistent with the diagnosis.

Biocompatible Materials↗

Supplemental vitamin A prevents the tumor-induced defect in wound healing.

To test our hypothesis that supplemental vitamin A would mitigate the impaired healing that occurs in tumor-bearing animals, six groups of C3H mice, eight per group, eating a standard commercial mouse chow ad libitum that supports normal growth, reproduction, and longevity were innoculated with 200,000 C3HBA cells. When tumors measured approximately 6 mm in diameter, the mice were anesthesized and wounded (dorsal skin incisions and subcutaneous polyvinyl alcohol sponges). Twenty-four hours later, two groups (one continued on the chow and the other started on the chow supplemented with 150,000 IU vitamin A/kg chow) underwent local tumor irradiation; two groups, one ingesting the chow, the other the vitamin A supplemented chow, were started on cyclophosphamide therapy; two groups, one ingesting the chow, the other the vitamin A supplemented chow, received neither local tumor irradiation nor cyclophosphamide therapy. An additional two groups ingesting the chow, one group neither innoculated with tumor nor wounded, the other wounded by not innoculated, served as controls. Wound breaking strength and sponge reparative collagen accumulation (assessed by hydroxyproline proline measurement) were used as indicators of wound healing. The mice were killed 12 days after wounding. Tumor presence decreased wound breaking strength and sponge hydroxyproline content; these effects were largely negated by supplemental vitamin A. Local tumor irradiation diminished the adverse effect of tumor on sponge reparative collagen content but to a lesser extent than the supplemental vitamin A. Supplemental vitamin A added to the irradiation effect on healing but irradiation did not add to the vitamin A effect. Cyclophosphamide, a systemic radiomimetic anti-tumor agent, did not alter the impaired wound healing of the tumor-bearing mice. Supplemental vitamin A mitigated the impaired wound healing in the cyclophosphamide-treated tumor-bearing mice. Supplemental vitamin A also moderated the effects of wounding, tumor, and tumor therapies (local irradiation and cyclophosphamide) on the increase in adrenal size, leukopenia, thrombocytopenia, and thymic involution (except the last was not moderated in the cyclophosphamide-treated tumor-bearing rats). The splenic enlargement in the untreated tumor-bearing wounded rats and in those treated with cyclophosphamide was lessened by supplemental vitamin A. We hypothesize that these anti-stress effects of vitamin A underlie, in part, its action in mitigating the impaired wound healing of tumor-bearing mice, including those treated by local irradiation or cyclophosphamide. These findings have implications for the care of patients with malignant tumors.

Animals↗

Fetal wound healing: a biochemical study of scarless healing.

Human fetal surgery is being successfully performed today in a small number of highly selected patients for conditions that may lead to irreversible damage to the fetus and threaten the viability of the newborn. Following surgical repair, fetal wounds heal without scarring. This study was initiated to characterize fetal wounds both histologically and biochemically. Gore-Tex tubing was implanted into the subcutaneous tissue of the back of fetal, newborn, and adult New Zealand white rabbits. Light microscopic examination of healed wounds revealed no evidence of scar formation. Electron microscopy demonstrated a striated fibrillar structure suggestive of collagen within the lumen of the Gore-Tex tubing implants. Amino acid analysis (sensitivity 40 pmol) confirmed the presence of hydroxylysine and hydroxyproline within the Gore-Tex wound chambers indicating the presence of collagen in fetal wounds. The small amount of collagen precluded the typing of the collagen using cyanogen bromide peptide analysis. The absence of scarring and the small amounts of detectable collagen suggest a high degree of reorganization of the connective tissues involved in repair. The fetal wound matrix is rich in hyaluronic acid. Topical hyaluronic acid has been associated experimentally with a reduced amount of scarring in postnatal wound healing. Hyaluronic acid extracted from human skin and scar tissue is associated with collagen and other proteins. We propose that a hyaluronic acid-collagen-protein complex may play a role in fetal wound healing.

Amino Acids↗