Biomedical subjects
Publications and source records attributed to L Clodius.
This Commentary provides the reader with various motivations and psychologic factors patients have for refusing as well as for accepting long-term therapy of lymphedema.
Regional complications after axillary lymphadenectomy are common and usually involve perioperative skin dehiscence, wound infection, and seroma formation and later arm lymphedema. Gentle handling of tissues during operation, and routine use of closed catheter suction drainage with direct external axillary compression with immobilization of the shoulder after nodal dissection are advocated to minimize both the early and late sequelae. Healing by primary intent is facilitated and the opportunity for reconnection of divided lymphatics (lymphangiogenesis and lymphvasculogenesis) are thereby optimized.
The revascularization of free nerve grafts wrapped in omentum was assessed in an experimental model using rats. Revascularization of the grafts, using the original vessels, proceeded in the same way as reported in earlier studies, being in progress on the 4th day after the operation and essentially complete on the 8th day. The observations made in the experiment suggest that using omentum does not offer much of an advantage with nerve grafts transplanted to tissues with a good blood supply. Using omentum would seem indicated for grafts transplanted into cicatrized or irradiated tissues.
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Diagnostic criteria of vascular lesions in the face were studied in a series of 57 patients investigated and treated during the years 1980 to 1990. Twenty-eight had hemangiomas and malformations, and 29 had telangiectasia. At present, the histological diagnoses are most commonly used to describe vascular lesions, but unfortunately this gives little idea of the actual appearance of the lesion. In the present study, the clinical appearance was compared and correlated with the findings at the time of surgery, with the angiographs, and with the histological diagnosis. An attempt was undertaken to coordinate the accepted clinical, microscopic, and angiographic classifications with our own results. Based on the modern concepts of pathology of angiogenesis and the conclusions drawn from our present investigation, the "new," unifying classification of vascular lesions was compiled. This classification is presented in the form of a diagram.
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Twenty-one vascular malformations located in the facial area, 11 high-flow arteriovenous malformations and 10 slow-flow malformations, underwent combined treatment by embolization and later surgery. Embolization was performed simultaneously with superselective angiography of the branches of the external carotid artery. The new biodegradable fibrosing agent Ethibloc was used in 16 cases. Histologic examination of the surgical specimens confirmed the good target orientation by the transarterial injection of Ethibloc. Limitations of this technique are discussed. The agent proved to have thrombogenic and fibrogenic properties. Some of the vascular walls degenerated and ruptured following the embolization, but there were no instances of necrosis of interstitial tissue or skin. Embolization treatment of vascular malformations of the face was not curative, but it facilitated subsequent surgery in all examined cases.
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A case is described of gangrene of the foot and lower leg due to cold injury following exposure to liquid nitrogen. The severe damage to the entire microcirculation was followed by irreversible ischemia finally requiring amputation of the lower leg. Histology revealed conspicuous lesions of the small vessels within the entire soft tissues, with subsequent thrombotic occlusion and circulatory blockade. Some recommendations concerning occupational exposure to liquid nitrogen are added.
Pathophysiology of lymphedema is not an enigma. It is caused by a low-output failure of the lymph vascular system in combination with an inadequate scavenging of stagnating plasma protein by macrophages. Axillary venous diseases alone never cause chronic postmastectomy edema. In the diagnosis of lymphedema, invasive methods (i.e., direct lymphography and venography) are not only unnecessary but are potentially harmful and do not give any information of therapeutic relevance. Lymphedema of the limbs without reflux of lymph or chyle is not a surgical disease. It can be treated successfully by the skillful application of specific physiotherapeutic measures free of any side effect. The results of this therapy can be maintained if the patient's compliance is good.
The effect of coumarin is investigated on the morphological features of members of the mononuclear phagocytic system (MPS) attaching to subcutaneously (s.c.) implanted coverslips in "normal" and chronically lymphedematous tissues. In untreated "normal" tissues there was no attachment suggesting that the presence of lymphedema elsewhere influences MPS activity. Coumarin restored attachment proportions to those found in normal tissues of dogs with no lymphedema. In lymphedema, coumarin significantly increased the proportion of macrophages which were round with less than ten pseudopods (new recruits) and the proportion with distinct pseudopods combined with more than ten vacuoles (active elicited members of the MPS). Coumarin resulted in a significant decline in the proportion of macrophages which were round and with more than ten apparently lipid-containing vacuoles, suggesting a facilitation of their removal to other sites.
The principle and the many technical details of surgical treatment for large facial port-wine stains are outlined. The treatment consists of subtotal excision of the port-wine stain, retaining the dermal base and covering the defects with carefully selected full-thickness skin grafts. Complications and results are discussed.
In contrast to true hemangiomas, which are vascular neoplasms, port-wine stains (PWS) are vascular malformations. They consist of mature teleangiectatic vessels in the dermis and the adjacent subcutis. The series of 50 patients here reported have been treated by subtotal excision of their PWS, covering the resulting defects with carefully selected full-thickness skin grafts.
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