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Biomedical subjects

Ned Snyder

Publications and source records attributed to Ned Snyder.

6 recordsLinked to original sources
PubMed2006

APRI: an easy and validated predictor of hepatic fibrosis in chronic hepatitis C.

GOALS: To evaluate the aspartate aminotransferase/platelet ratio index (APRI) as a predictor of the presence or absence of significant fibrosis on liver biopsy of patients with chronic hepatitis C (HCV). BACKGROUND: The decision to treat HCV is often made on the basis of the presence or absence of significant fibrosis on the liver biopsy. Because liver biopsy is expensive and invasive a noninvasive marker to evaluate hepatic fibrosis would be useful. The APRI is an easy to calculate index that is one of several markers that have been proposed. STUDY: We retrospectively reviewed the charts of 339 patients with chronic HCV who had liver biopsies from January 2000 to March 2003. We subsequently evaluated 151 patients receiving pretreatment evaluation liver biopsies who had serum aspartate aminotransferase, platelets, routine liver function tests, and demographic data obtained. All liver biopsies were staged by the Batts Ludwig criteria. RESULTS: The area under the curve of the receiver operator characteristics of the calculated APRI compared with the liver biopsy demonstrated that the fibrosis score was 0.889 in the prospective group and 0.790 in the retrospective group. To achieve predictive values of approximately 90%, useful cutoffs were found at 0.40 and 1.5 in the retrospective study, and 0.42 and 1.2 in the prospective study leaving intermediate zones of 58.9% and 41.1%, respectively. In the prospective group, 34 of 36 patients with a value of <0.42 were accurately predicted as having mild fibrosis, whereas 50 of 54 patients with a value >1.2 were accurately predicted to have significant fibrosis. CONCLUSIONS: The APRI is a good estimator of hepatic fibrosis and was more accurate in a prospective group than a retrospective one. It potentially could be used to decrease the number of liver biopsies.

Adult↗
PubMed2006

Delayed type IV muscle flap in a feline model.

The concept of delaying a skin flap is well established and has been implemented into plastic surgery practice for years. Some investigators have delayed musculocutaneous flaps to improve the perforator inflow. To our knowledge, the concept of delaying a muscle flap had previously never been tested in a model with segmental pedicles. Five cats each underwent 3 sequential operations providing them with a sartorius muscle whose blood supply was a single distal pedicle. The opposite leg was used as a control. Our delayed type IV muscle flap demonstrated perfusion to the proximal tip of the sartorius muscle without necrosis or loss of muscle mass (P < 0.0001). The control showed no evidence of perfusion beyond the distal portion of the muscle when infused through the distal pedicle. The delayed flap can survive on a distal blood supply that would not be adequate in a single-stage procedure. This flap has an increased arc of rotation that may provide solutions to difficult reconstructive problems in the groin, lower abdomen, genitalia, knee, proximal leg, and might be suitable as a free flap.

Animals↗
PubMed2005

The incidence of tuberous breast deformity in asymmetric and symmetric mammaplasty patients.

BACKGROUND: Breast asymmetry is commonly accompanied by tuberous deformity. To date, no study has reported the incidence of this breast deformity in the presence of asymmetry. A retrospective analysis of standard preoperative photographs was performed on 375 consecutive female patients presenting for mammaplasty over a 10-year span. METHODS: Women were examined for symmetry, asymmetry, and the presence of tuberous deformity. Patients were graded by the Grolleau Classification System. Patients having congenital anomalies, tumors, infection, radiation, chest wall deformities, previous breast surgery history, and incomplete chart data were excluded. RESULTS: Of the 375 patients studied, 81.1 percent (n = 304) presented with asymmetry. Of these asymmetric women, 88.8 percent (n = 270) were found to have tuberous deformity. Of the 71 patients who were symmetric, 7 percent (n = 5) were tuberous. Concurrent nipple-areola complex involvement in the tuberous asymmetric patient population was present in 50 percent of the women (n = 116). Of the tuberous deformities with nipple-areola complex, 87.9 percent (n = 116) were Grolleau type III. Nipple-areola complex involvement was not found in any of the symmetric patients. Of the 275 women with tuberous deformity, 531 breasts were tuberous and 60.3 percent (n = 320) were Grolleau's type III. In total, 57.1 percent of all reduction mammaplasties (n = 92) and 83.2 percent of all augmentation mammaplasties (n = 178) had asymmetry with tuberous deformity. CONCLUSIONS: This is the first published study to demonstrate that tuberous deformity is strongly associated with asymmetry in women presenting for mammaplasty. This should be evaluated in preoperative planning to ensure optimal outcome. Patients with this deformity should be educated preoperatively so their expectations of postoperative results are realistic.

Breast↗
PubMed2002

Experimental nonsurgical tattoo removal in a guinea pig model with topical imiquimod and tretinoin.

BACKGROUND: Tattoo removal is a common request in dermatologic surgery practices. Conventional tattoo removal modalities consist of mechanical, chemical, and thermal methods, but these interventions may result in undesirable dermal damage, disfiguring scars, and pigmentary changes. OBJECTIVE: To evaluate the efficacy of topical imiquimod and tretinoin for the removal of tattoos in a guinea pig model. METHODS: Five albino guinea pigs (A-E) were tattooed with black, red, green, and yellow. Beginning 6 hours after tattooing, A received no treatment, B was treated with petrolatum, C had imiquimod cream alternating with tretinoin gel, D had imiquimod cream alone, and E received tretinoin gel alone. The animals were treated for 7 days. Biopsies of the tattoos were taken at 6 hours, 7 days, and 28 days. RESULTS: Control guinea pig B had normal-appearing tattoos with consistent histopathology on day 28. Guinea pig D, treated with imiquimod cream clinically, had no visible tattoo, consistent with greatly diminished or no dye evident on histopathology. Guinea pig E, treated with tretinoin gel, and guinea pig C, treated with combination tretinoin gel and imiquimod cream, had faded tattoos and moderate clearance of pigment on histopathology. CONCLUSION: In the guinea pig, the use of imiquimod was successful as a nonsurgical method of acute-phase tattoo removal, but was associated with fibrosis and the loss of dermal appendages.

Administration, Topical↗