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Biomedical subjects

P J Chandler

Publications and source records attributed to P J Chandler.

At least 19 recordsLinked to original sources
PubMed2003

Frequency and distribution of talc contamination in patients with silicone gel-filled breast implants.

Talc was found to contaminate peri-implant scars in patients with silicone gel-filled breast prostheses resulting from the physical interaction between implant and surgical glove. This study reports the frequency and distribution of the problem and its relationship to changes in glove manufacture. Peri-implant scar tissue, obtained from a population with breast implants, was evaluated for talc. Patients were considered positive if more than two talc particles were seen intracellularly in more than two microscopic fields. The largest Texas glove manufacturer stopped using talc in 1983. Patients were grouped to demonstrate the difference in talc exposure in Texas after this manufacturing change. Of those receiving implants before 1984, 136 of 140 were positive for talc. Of those receiving implants after 1983, 24 of 54 were positive (p < 0.000; RR = 42.5; CI: 13.7-131.6). Widespread prevalence of contamination was evidenced by findings of talc in patients from various facilities, different surgeons, and multiple sites within Texas.

Adolescent↗
PubMed2000

Provider gender preference in obstetrics and gynecology: a military population.

OBJECTIVE: This study evaluates patient reasons and preferences for gender selection of their obstetrician-gynecologist. METHODS: A written survey was given to patients attending a military obstetrics and gynecology clinic (N = 203). Mean age was 36 years, with 69% of patients between 20 and 40 years. Caucasian (52%) and African American (34%) were the most common races. RESULTS: Overall, 52% of patients preferred a female practitioner, 4% preferred males, and gender did not matter for 44%. Experience and reputation were the most important factors in 93% of all patient provider selections. Only 10% of patients felt that gender was the most important factor, and 35% ranked gender as one of the top two factors. CONCLUSION: Although a majority of our study population preferred female obstetrician-gynecologist providers, experience and reputation were more frequently cited than gender as the most important factors in selecting a provider. Patients felt that female physicians understand their problems better.

Adolescent↗
PubMed1999

The deposition of talc in patients with silicone gel-filled breast implants.

This study was initiated to understand why talc was found in the entrance wounds and pericapsular scars of patients with silicone breast implants. Twenty-five surgical gloves made between 1977 and 1992 by a major glove manufacturer were evaluated with infrared spectroscopy. Seven gloves manufactured before early 1983 contained talc. Later manufactured gloves contained calcium carbonate instead of talc. Talc-containing gloves were submitted to independent laboratories for scanning electron microscopic examination and x-ray microanalysis to obtain finer detail. Remnants of the mold-release agent talc were found in the matrix of the patient-contact side of the glove. Wetting studies showed that silicone oil (gel bleed) immediately wet the surface of rubber glove. After donning, silicone oil was massaged between the thumb and index finger of each washed, talc-containing glove for 1 minute and then daubed from the glove to a microscopic slide. The slide was viewed with polarized light microscopy for the presence of talc crystals. Transfer of talc occurred using silicone oil, but not saline, in each talc-containing glove. Three factors were likely involved in the greater talc deposition that occurred with patients undergoing silicone gel-filled breast implantation than in patients undergoing other surgical procedures. (1) The wetting of the gloves with silicone gel bleed from implants loosened the talc in the glove matrix. (2) Hand-intensive surgical use freed the talc from the gloves. (3) Loose talc adhered to the silicone elastomer of the breast implants and was deposited with implant placement.

Breast Implantation↗
PubMed1994

Talc deposition in skin and tissues surrounding silicone gel-containing prosthetic devices.

BACKGROUND AND DESIGN: Periprosthetic capsule formation is the most common cause of morbidity associated with silicone gel-filled breast implants. All implant recipients develop capsules. However, the extent of capsule formation varies greatly among patients, ranging from a thin flexible membrane to a constrictive inelastic band of sclerotic collagen. Although silicone gel bleed has been proposed as the most likely cause of excessive capsular sclerosis, liquid silicone did not induce fibrosis in early clinical trials. Because many implant modifications have been introduced since the original studies were performed, a more plausible explanation for excess capsular sclerosis is the inadvertent introduction of a fibrogenic contaminant. The skin and periprosthetic tissues removed from 41 women during implant revision surgery were examined for the presence of foreign substances that might contribute to capsular sclerosis. Tissue was examined histologically with and without polarizing filters and with scanning electron microscopy equipped for energy-dispersive x-ray analysis. RESULTS: A high incidence of talc was found within the skin and tissues adjacent to silicone-containing breast prostheses. Birefringent talc crystals, identified in 71% of the patients, were observed within nodular granulomas and perivascular histiocytes. Two specimens containing talc crystals were analyzed by energy-dispersive roentgenographic analysis, which confirmed the identity of the crystalline material as talc. Among 10 capsules examined by direct immunofluorescence, there was no evidence of immune complex deposition. CONCLUSIONS: The high incidence of talc deposition in the skin and tissues surrounding silicone implants suggests that talc either is introduced at the time of implant surgery (possibly in association with the silicone elastomer bag, tissue sizers, or surgical gloves) or is released into the tissues as a silicone gel contaminant during gel bleed. Talc, a known sclerosing agent, may contribute to periprosthetic fibrosclerosis.

Adult↗
PubMed1991

Reflex sympathetic dystrophy and electroacupuncture.

Reflex sympathetic dystrophy (RSD) is a painful and progressively debilitating condition. Untreated, it leads to changes in the patient's lifestyle that are consistent with chronic pain syndrome. This general overview of contributing factors, signs and symptoms, diagnosis, and treatment of RSD presents three consecutive cases for which electroacupuncture (EA) proved to be an effective treatment for RSD pain. Possible underlying neuroanatomical mechanisms of RSD are addressed and the scientific basis for EA is considered briefly.

Adult↗
PubMed1990

A direct surgical approach to correct the inverted nipple.

Inverted nipples are cosmetically unpleasing to the patient and can become inflamed due to mechanical difficulty with cleaning the nipple-areola complex. A surgical technique for the permanent repair of inverted nipples is described. The rationale for the surgical approach is that the major pathophysiologic basis for nipple inversion is shortened lactiferous ducts. Briefly outlined, under local anesthesia, the nipple is everted with a skin hook and held in gentle traction while a small incision is made on each side at the nipple-areola junction. Breast ducts are then divided by sharp dissection, and a drain is inserted through the tunnel under the nipple. The drain is removed in 7 to 10 days. The patient must be informed before the procedure that breast-feeding will not be possible afterward because breast ducts will be permanently divided. Advantages to the procedure are (1) no scars on the areola, (2) no stricture from sutures, (3) adequate blood and nerve supply to the nipple, and (4) decreased risk of hematoma.

Adult↗
PubMed1990

Hanganutziu-Deicher antigen as a possible target for immunotherapy of melanoma.

Hanganutziu-Deicher (H-D) antigen is classified as a heterophile antigen and chemically defined as a glycoconjugate which contains N-glycolylneuraminic acid. H-D antigens are absent from normal human tissues, but can be expressed on a variety of human malignant cells, including melanoma. Natural anti-H-D antibodies have been detected in man with and without malignancies, but in this study when the level of antibody was compared between healthy adults and patients with melanoma, elevated anti-H-D antibody levels were found more frequently in melanoma patients for both IgM (p = 0.0001) and IgG (p = 0.0001). The present study was designed to evaluate the significance of the H-D antigen-antibody system in melanoma suppression. Sera from melanoma patients containing anti-H-D antibody reacted strongly to H-D antigen expressed on melanoma by means of flow cytometry. In a complement-dependent cytotoxicity assay this antibody killed melanoma cells in vitro. In vivo significance of the antibody was assessed by evaluating the relationship between the antibody levels and the clinical course in patients with stage II melanoma. Antibody levels were measured by enzyme-linked immunosorbent assay using a H-D glycoprotein antigen isolated from bovine erythrocytes. A significantly higher level of IgG (p = 0.0640) and IgM (p = 0.0644) anti-H-D antibody was demonstrated in those patients who were free of disease more than 5 years after surgery than in those who relapsed within 2 years. This study provides a rational basis for immunotherapy targeting H-D antigen in human melanoma.

Antibodies↗