Biomedical subjects
Publications and source records attributed to M S Granick.
Op-Site is a popular skin-graft donor-site dressing. The formation of hematomas or seromas with their troublesome consequences is effectively prevented by the incorporation of a closed drainage system.
An epidemiologic analysis is presented of the utilization patterns of an emergency department (ED) that treats otolaryngologic diseases. Descriptive data are collated and cross-tabulated from 2,504 patient contacts occurring during an eight-month period. Most patients use the facility as their primary physician contact during usual business hours. Most patients complain of an ear problem, and two thirds of the patients have one of 12 common disorders. The cost-effectiveness of an independent specialty ED is evaluated.
The defect resulting from partial or complete maxillectomy can often be reconstructed with a skin graft and a prosthesis. In situations where this simple maneuver is unsatisfactory, a more complex reconstructive modality, providing the restoration of composite tissue, is required. The scapular microvascular-free flap was used in this series of 11 patients, as a cutaneous flap in 3 and as an osteocutaneous flap in 8, to meet the specific reconstructive needs of each patient. Excellent to satisfactory restoration of facial contour and palatal function was achieved in 10 patients. There was 1 flap failure. There were no donor site complications. Selected case histories are presented to demonstrate a spectrum of reconstructive problems. There are clear limitations to its applicability, such as the odd scapular bone contour, the thickness of the cutaneous paddle, the position change required for flap harvesting, and the risk of flap failure. The scapular flap has proven to be useful in restoring bony and soft tissue contour of the face, rigid support for the velum, oronasal separation, support for the orbit, and obliteration of the maxillary sinus. We found the scapular-free flap to be a useful tool for reconstructing complex and variable maxillectomy defects.
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A retrospective study is presented comparing the results of 462 frozen-section analyses of surgically extirpated salivary gland tumors with the permanent-section results. The overall agreement between frozen- and permanent-section analyses was 95.7%. A separate review of the last 47 months of this 32-year study revealed an accuracy rate of 98.8%. Frozen-section diagnosis of salivary gland tumors has been reliable and clinically valuable in our practice.
The scapular osteocutaneous free flap provides excellent tissue for reconstruction of massive lower facial defects. Five cases of full-thickness cheek and lip defects associated with mandibular loss were successfully repaired with sandwiched osteocutaneous scapular flaps plus a parascapular or latissimus dorsi flap. In two instances the osteocutaneous scapular flap was harvested along with a parascapular skin paddle. The other three patients had latissimus dorsi myocutaneous units taken with the scapular osteocutaneous flap from the same subscapular pedicle.
A retrospective review of 36 cases of lymphoma presenting as a salivary gland mass was conducted over a 34-year period. A significant increase in the occurrence of lymphoma was noted in proportion to other salivary gland tumors (P less than 0.01, chi 2 analysis: 1954-1972, 11 of 714 (1.5%); 1973-1979, 9 of 201 (4.5%); 1980-1987, 16 of 265 (6.0%). The mean age was 61 years, sex distribution was equal, and 75% occurred in the parotid. Only 42% presented with signs or symptoms other than a painless mass. Glandular excision was done in early stages of the disease while biopsy was done at later stages. Frozen section analysis was accurate in all but one case and was useful in determining if biopsy were adequate. All patients were definitively treated with chemotherapy and/or radiotherapy. Several instructive points are apparent. Any patient presenting with an isolated salivary gland mass can have a lymphoma. There has, in fact, been a significantly increasing proportion of salivary gland lymphoma among the various salivary gland tumors in our patient population. In contrast to other salivary gland tumors, surgery is reserved for diagnosis and not for treatment. A lymph node biopsy may be sufficient to establish a diagnosis, in which case, glandular excision is unnecessary. Most of the patients presented with an asymptomatic isolated salivary gland mass. The presence of adjacent adenopathy, a rubbery feel to the mass, and the intraoperative appearance were the most suggestive signs of lymphoma. Frozen section analysis is helpful in determining the appropriate extent of surgery and is recommended.
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Thrombospondin-1 (TSP-1), an adhesive glycoprotein, plays an important role in platelet adhesion, inflammation, cell-to-cell interaction, and angiogenesis. TSP-1 is expressed by endothelial cells, fibroblasts, and macrophages. TSP-1's unique cysteine-serine-valine-threonine-cysteine-glycine (CSVTCG) specific receptor plays an important role in the binding and modulation of cellular adhesion and invasion. This article histologically and quantitatively evaluates TSP-1 and its CSVTCG receptor in adult burn wounds over time. Tissue was obtained from burn wounds on several days and samples that were 5 microns thick were placed on slides. Expression of TSP-1 and its CSVTCG receptor were evaluated immunohistochemically and quantitated by computer image analysis in units of absorbance. Immunoglobin G (IgG) (negative) controls were performed and subtracted from the TSP-1 sample to eliminate background absorbance readings. Serum (negative) control was used for the CSVTCG receptor. Platelet concentrates were used as the positive control. A quantitative examination of the results yielded the following information, expressed as absorbance +/- standard error of the mean: TSP-1: day 1, 62.0 +/- 10.13; day 3, 76.2 +/- 6.90; day 5, 36.0 +/- 3.96; day 7, 60.4 +/- 5.67; and day 9, 29.5 +/- 2.91. TSP-1 displays an early peak, followed by a steep decrease over the time period studied. The readings for the CSVTCG receptor are as follows: day 1, 33.8 +/- 1.87; day 3, 34.5 +/- 5.39; day 7, 39.1 +/- 1.93; day 21, 39.1 +/- 1.93; day 28, 34.8 +/- 3.67. In contrast, the CVSTCG receptor continues to be present in the wound over time. Histologic findings are reported, and photographs and a histopathologic analysis are included. The information presented in this article leads to the conclusion that temporal and histologic differences exist in the localization and expression of TSP-1 and its CSVTCG receptor. TSP-1 is up-regulated in injured tissues immediately after the injury; it is rapidly down-regulated as the tissue heals. In contrast, the levels of the CSVTCG receptor remain relatively constant during the healing process. These data are consistent with TSP-1's known role in cell-to-cell interaction, including the modulation of the growth factor and protease activity.
Cerebellopontine angle (CPA) meningiomas constitute about 1% of intracranial meningiomas. The clinical aspects of a series of 32 patients with surgically confirmed CPA meningiomas are analyzed. The most common symptoms at the time of the initial evaluation were from the eighth cranial nerve (unilateral hearing loss--24 patients, vertigo or imbalance--19 patients, tinnitus--11 patients), and the fifth cranial nerve (altered sensation--9 patients, facial pain--5 patients). On examination, the most common findings were absent caloric response (19 patients), nystagmus (16 patients), diminished facial sensation (14 patients), ataxia (13 patients), reduced hearing (9 patients), and facial weakness (9 patients). There was often a long interval from the onset of symptoms to the correct diagnosis of a tumor. Brain stem auditory evoked potentials, blink reflex testing, posterior fossa myelography, computerized tomographic scanning, and angiography were abnormal in all patients in whom the test was done, but all tests were not performed on all patients. Computerized tomographic scanning and angiography are important for definitive diagnosis and for planning surgical treatment. The histopathology of the temporal bone was studied in three patients with meningiomas in the region of the internal auditory meatus.
Pressure ulcers may occur in patients with chronic illnesses, especially in those who are bed-bound or chair-bound. Local measures usually suffice to allow primary ulcer healing and support skin grafting or tissue transfer reconstruction. On rare occasions, however, pressure ulcers may progress to invasive infection and necrosis of adjacent soft tissues, possibly leading to necrotizing fasciitis. Early recognition and aggressive medical and surgical therapy are required to halt disease progression and prevent patient mortality. Two cases are presented to describe the severity of this soft-tissue infection.
The cost of community- and hospital-acquired pressure ulcers is particularly high in terms of both patient morbidity and economics. Multidisciplinary wound care teams were developed independently at two different hospitals to deal with the needs of patients with pressure ulcers and to control costs. Although the goals of the teams at both institutions were similar, the strategies for achieving the goals were different because they were adapted to the needs of the particular institution. As a result, care and prevention of pressure ulcers have improved at both hospitals.