Biomedical subjects
Publications and source records attributed to L Bartholdson.
A baby boy presented with a double tongue combined with a median cleft palate. He was otherwise normally developed. The double tongue was reconstructed to form one tongue 40 days after birth. At follow-up examination when he was 6 months old the tongue was well formed with normal function.
During the five year period 1980 to 1985 bone grafting was performed in 37 cleft patients before the eruption of the canine tooth (group IBG) and in 30 patients after the eruption of the canine tooth (group SGB). The initial healing was more favourable in the IBG group. In 72.5% of the clefts oro-nasal fistulae were present preoperatively. In all cases the fistulae were successfully closed. In the IBG group with orthodontic closure of the gap in the dental arch the interdental bone height in the grafted area was more than 75% of normal bone height in all clefts. In group SBG this situation was found in only 66% of the bone-grafted areas. There seems to be a clear relation between the age or the developmental stage of the canine tooth on the one hand and the possibility of orthodontic closure of the gap in the dental arch and good interdental bone height on the other hand. This also leads to the suggestion that if bone grafting to the alveolar cleft is required the operation should be performed before the eruption of the canine tooth on the cleft side.
A report is given on the treatment of keloids and hypertrophic scars using ordinary zinc tape. Among 41 patients who had their keloids or hypertrophic scars covered with zinc tape, the size of the scars in 23 patients was reduced to the level of the surrounding skin within the mean treatment time of 6 months. In the remaining patients the size of the keloids also decreased and treatment is being continued. The itching decreased in all the 37 patients who suffered from itching before tape treatment and in 20 patients it disappeared totally. The redness of the scars decreased in all cases.
In 5 selected patients with squamous cell carcinoma of the vulva invading the anus, a vulvectomy in combination with proctectomy and in three cases bilateral groin dissection en bloc, was performed. All five patients had microscopically well differentiated tumors and no one showed evidence of distant metastases. All five patients are now alive and well with a mean observation time of 8 years. It is concluded that in selected patients, extensive surgery for invasive squamous cell carcinoma of the vulva can be very rewarding.
In a prospective study, 169 patients with invasive squamous cell carcinoma of the vulva were treated by radical surgery. One hundred patients, without palpable inguinal lymph nodes, had a vulvectomy only, and the remaining 69 underwent vulvectomy in combination with groin dissection. Different prognostic factors were analyzed, and the results of radical surgery were evaluated. It was found that a small, exophytic, microscopically well differentiated tumor confined to one anatomic area will carry the best prognosis. Conversely, a patient with a large, endophytic, poorly differentiated tumor with inguinal lymph node metastasis will have the least favorable outcome. If there is metastatic spread to the deep inguinal node, Rosenmüller, the prognosis is quite bad. The crude five year survival rate was 56 per cent and the corrected survival ate was 65 per cent. Eleven patients died of early complications, seven of pulmonary embolism. It was concluded that radical surgery gives the best cure rate. It is suggested that operation for invasive squamous cell carcinoma of the vulva in all patients should consist of vulvectomy with primary skin grafting and bilateral superficial inguinal gland excision en bloc.
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From the central part of the labium majus the lymphatic transport of 198Au is invariably bilateral to inguinal and pelvic lymph nodes. Thus, bilateral inguinal and low pelvic lymph-adenectomy is logical in the treatment of carcinoma of the vulva. 198Au injected subcutaneously and Lipiodol injected intralymphatically in the dorsum of the foot were transported exclusively to ipsilateral inguinal and pelvic lymph nodes. Thus, there is no need for contralateral lymphadenectomy in malignancies on the dorsum of the foot.
Extensive lymph node dissections have been performed in an attempt to increase survival after abdomino-perineal excision or anterior resection of the rectum for carcinoma. The lymph drainage from the upper and middle third of the rectum was demonstrated by means of 198Au which was injected into the submucosa. Less than one percent was drained to pelvic lymph nodes, giving little support for pelvic lymph node dissection for carcinoma in the upper and middle third of the rectum.
A comparison between two tracers, the one colloidal suspension of 198Au, the other 169Yb-labelled microspheres of 8 to 10 micron has been made concerning lymphatic and hematogenous spread from the submucosa in the rectum in dogs. Both tracers have, in principal, the same distribution. It was therefore considered that a colloidal suspension of 198Au is a useful tracer for functional anatomic investigations of lymph drainage.
The lymphatic transport of a radioactive tracer injected intralymphatically on the dorsum of the foot was determined before and after surgery in 3 patients with vulvar carcinoma. The centrally recorded activity curves showed different time courses before and after inguinal lymphadenectomy, suggesting that the lymphatic transport is short-circuited via lymphovenous anastomoses after lymphadenectomy. Thus, non-radical surgery for primary carcinoma combined with lymphadenectomy will increase the risk of haematogenous spread.
Human cadaver split skin preserved in a special transport medium (Histocon; Histo-Lab. Ltd., Göteborg, Sweden) and porcine split skin (Skintec; Genetic Lab. Inc., Minneapolis, USA), were used in thirteen patients with infected wounds. Cadaver skin made it possible to reduce applications of wound dressing to two or three times a week without aggravation of infection and made the wound bed suitable for autografting. Skintec was less reliable in these respects. The two biological dressings had equal pain reducing properties. Leukocyte agglutinins, attributable to the treatment with cadaver skin did not appear. Because of retained histological and histochemical characteristics in the preserved cadaver skin it was preferred to Skintec. A regimen consisting of initial wound toilet, antibiotic treatment, skin changing every second or third day finally made permanent skin grafting possible. Secondary gains were a reduce in nursing and dressing routine as compared to saline dressings.
Four patients with Xeroderma pigmentosum are reported: 2 diagnosed following the development of multiple cutaneous tumours, and 2 at an earlier state. The repair synthesis of DNA after ultraviolet radiation was reduced in 3 and normal in 1 patients. Para-aminobenzoic acid (PABA) was used topically as sunscreen; for those intolerant to PABA, alternatives are given. 5-fluoro-uracil had satisfactory effect against actinic keratoses. Two patients had associated neurologic and mental abnormalities compatible with deSanctis-Cacchione syndrome, a Xeroderma pigmentosum variant.
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The in-vitro antimicrobial effect of certain biological dressings was analysed. Glass basins lined with inverted human or pig skin treated and stored in various ways were inoculated with Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Glass basins served as controls. Human split skin from cadavers or living donors, deep frozen or preserved in Histocon and fresh-frozen pig had marked inhibitory activity. Heated skin and beta-irradiated pig skin did not have this effect. The antimicrobial effect was not observed during the first 2 hours of incubation but was present after 24 and 48 hours. It was not dependent on serum factors, It is concluded that when a biological dressings is used, advantage should be taken of its bactericidal activity, as infection is often a problem in sound dressing.
203 cancers of the eyelid were operated on in 193 patients. 65% of the tumours occurred in males and the peak incidence was at 75 years. 60% afflicted the lower eyelids and 21% the medial canthi. Basal cell carcinoma were found in 182 specimens and spinocellular carcinoma in only 8. Malignant melanoma, Meibomian gland carcinoma and rhabdomyosarcoma appeared each in one patient, the latter representing the only fatal case in eyelid cancer. All cancers were excised with a free margin around 5 mm. The standard procedures of reconstruction of the eyelid defect were a fullthickness skin graft in cases where conjunctiva and tarsus could be preserved (97 cases), and a tarsoconjunctival flap in full-thickness defects of the lower eyelid (58 cases). Other methods used were wedge excision and direct approximation in very small lesions involving the lid margin, an infratarsal island flap from the lower eyelid for medium-sized to large defects in the upper lid and a forehead or scalp flap after exenteration of the orbit. 18/203 cancers recurred and 12 of these were primarily regarded as radically treated. Seven of the latter were reoperated after more than 3 years and may in fact be new tumours. No metastases were found. The various reconstructive procedures are discussed in detail
Chronic suppurating perineal sinuses are common following proctocolectomy for ulcerative colitis and Crohn's disease. Repeated surgery along conservative lines is often likely to result in failure. If a tissue with normal potentiality for healing is brought to the area of delayed healing, a reasonable chance of success will be achieved. This hypothesis was put forward by Graham (1965) who supported his theory by presenting outstanding results by using a pedicle flap of gracilis in the treatment of rectovaginal fistulas following irradiation. In the present study, Graham's technique was adapted in the treatment of chronic persistent perineal sinuses. The results are promising and the procedure is worth trying in the treatment of longstanding sinuses which fail to heal by conservative methods.
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