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Biomedical subjects

R A Ersek

Publications and source records attributed to R A Ersek.

At least 55 records · Page 3Linked to original sources
PubMed1989

Hereditary progressive nodular lipomatosis: a report and selective review of a new syndrome.

Multiple hereditary lipomatosis has been reported very rarely in the literature. The largest number of lipomas previously reported in a single patient was 160. We report on a 45-year-old man who began to experience multiple lipomas at about age 26. The lipomas multiplied until they severely disfigured his entire torso, arms, and upper legs. Both sides of his body were affected to approximately equal degrees. A family history revealed that the patient's father, two brothers, and two nephews have all experienced multiple subcutaneous lipomas, although to a lesser degree. In treating the patient, what appeared to be very large lipomas were in fact found to be subcutaneous clusters of hundreds of small encapsulated lipomas. Lipomas were excised using suction lipectomy to treat different involved areas on eleven separate occasions. A total of 8,475 cc was removed over a two-year period. A modified, slightly less blunt cannula was developed to aspirate the clustered lipomas individually.

Humans↗
PubMed1989

Serial suction lipectomy.

Serial suction lipectomy is a safe method whereby larger areas and larger amounts of subcutaneous fat can be removed in several subsequent steps to minimize transfusion, minimize hospitalization, and maximize the improved health and safety of our patients. Six weeks should elapse between major resections, and a maximum of 2000 cc can be removed at one time unless transfusion is available.

Adult↗
PubMed1988

Processed irradiated bovine cartilage for nasal reconstruction.

Immunological studies in mice and humans have demonstrated that glutaraldehyde-processed, irradiated bovine cartilage elicits a nearly undetectable immune response, even on second-set provocative implantation in humans. Previous clinical studies have shown that this material performs in a manner comparable to irradiated allograft cartilage as an implant material for facial contour restoration. We used implants of bovine cartilage processed by irradiation and glutaraldehyde cross-linking for nasal reconstruction in 53 patients. In 50 of these cases, the implants remain in place, without observable changes in size or shape, after periods ranging from one to seven years. Two implants were lost to apparent absorption within fifteen months. A third implant was palpably in place after five years but was undetectable two years later. Ten of the surviving implants have been in place for three years or longer, and 4 over five years. In most cases, implants of processed, irradiated bovine cartilage appear to be firmly encapsulated, dimensionally stable, and immunologically inert after periods in situ during which more primitive bovine cartilage implants consistently have been absorbed. Our results are confirmed by x-ray examination and enzyme-linked immunosorbent assay.

Animals↗
PubMed1986

Suction-assisted lipectomy for correction of 202 figure faults in 101 patients: indications, limitations, and applications.

Since its introduction in the United States, suction-assisted lipectomy has proven to be a safe, effective technique for correction of figure faults. It has been greeted with considerable skepticism by many practitioners, however, owing to the poor results many have obtained in their initial attempts to apply similar techniques. Suction lipectomy using the blunt technique is a safe procedure that can yield consistently good results when appropriately applied. It is suggested that the principal reason others have had difficulty involves problems in patient selection. The technique may not be effective for the correction of generalized obesity and cannot be expected to dramatically alter overall appearance. Patients should be selected for treatment of specific "figure faults" and educated as to what may realistically be expected. The patient's emotional and psychological condition must be taken into consideration. We report a series of 101 patients treated with a total of 202 separate suction lipectomy procedures with good results and only two minor complications. A survey of patients treated by the method reveals a generally high level of satisfaction and some of the ambivalence that might be anticipated from such a technique.

Adipose Tissue↗
PubMed1986

Breast biopsy technique: a plea for cosmesis.

Breast cancer is the leading cause of cancer death among American women. Early detection and treatment greatly increase long-term survival rates, but many women delay seeking treatment of suspected lesions out of fear of mutilation. Unfortunately, this fear is compounded by the fact that although 60% to 80% of all biopsies prove benign, many women are left with unsightly scars from the biopsies themselves. The great majority of these avoidable scars result from the use of radial biopsy incisions, which are unnecessary in virtually all cases. Most lesions can be reached via periareolar incisions and even those few that require incisions away from the areola can be reached through incisions that follow Langer's lines circumferential to the breast. Even total subcutaneous mastectomy and reconstruction can often be done via periareolar incisions, with minimal scarring, less likelihood of keloid formation, no deformity, and less emotional trauma for the recovered patient.

Adult↗
PubMed1984

Processed bovine cartilage: an improved biosynthetic implant for contour defects.

Irradiated human cartilage has been found to be a superior implant material for correction of contour defects; however, availability problems have prevented this material from gaining wide acceptance. Implantation of processed irradiated bovine cartilage in primates and rabbits, as described here, provides strong evidence that this material performs like irradiated allograft cartilage antigenically and has certain cosmetic advantages over allograft cartilage. Our studies in primates have shown that there is no systemically measurable antibody-antigen reaction, either cellular or noncellular, to irradiated processed bovine cartilage. Neither primary nor second-set provocative implantations produced any measurable rejection. In rabbits, composite grafts of two pieces of irradiated bovine cartilage adjacent to each other were also well tolerated, with no measurable absorption and with capsule formation typical of a foreign body reaction to an inert object.

Animals↗
PubMed1984

The island pedicle rotation advancement gastrocnemius musculocutaneous flap for complete coverage of the popliteal fossa.

The medial head of the gastrocnemius flap is a large, versatile flap that can be used to cover areas above the popliteal fossa, thereby minimizing the necessity for amputation in many traumatic injuries to this area. By advancing the medial head of the gastrocnemius muscle and rotating it on the neurovascular pedicle of the medial sural vessels, we have covered a 17 cm X 20 cm defect of crushed muscle, tendon, and bone in a leg that was traumatically amputated proximal to the knee. This procedure makes possible muscular coverage for bone, stainless steel plate, and reanastomosed arteries and veins above the knee and provides skin coverage extending to 70% of the circumference of the popliteal fossa. Autografting provides coverage for the remainder of the wound. Subsequent extension and flexion of the viable knee joint was achieved.

Adult↗
PubMed1984

Clinical use of an improved processed bovine cartilage for contour defects.

We have combined irradiation with a new chemical processing to cross-link the collagen of bovine cartilage, thereby stabilizing the collagen molecule and rendering it antigenically inert and dimensionally stable. Irradiated allograft cartilage has been successfully used for repair of facial contour defects since the 1950s, but the usefulness of this material has been limited by lack of availability. Chemically processed bovine cartilage had previously been used, but the implants were subject to slow degradation and were usually absorbed completely within 2 years. After first testing this new material on rabbits and primates, we experimentally placed 40 implants in 28 patients over the course of 3 years. Thirty-six of these implants have survived without change in size or shape for more than 1 year, 20 of these for more than 2 years. In 2 cases, full or partial absorption of the implants occurred secondary to operative infection. In another case 2 implants were lost, probably because of infection. In the absence of infection, neither primary nor second-set provocative implant tests of processed irradiated bovine cartilage elicit any foreign body reaction, either cellular or noncellular. The material performs well aesthetically and appears to undergo no absorption during the 1- to 4-year follow-up observed to date. The period of follow-up of 1 to 4 years reported here may be insufficient to reach a definitive conclusion that no very slow absorption of processed irradiated bovine cartilage implants occurs. It is noteworthy, however, that half of the implants have already survived with no apparent absorption for a period longer than that at which nonirradiated bovine cartilage implants would be expected to have been absorbed completely. This result suggests that any absorption that may occur, other than that associated with infection, takes place at a rate so slow as to be unobservable in anything but the very long run. We believe that this evidence of the long-term survivability of processed irradiated bovine cartilage, together with its excellent performance aesthetically and the fact that it can be made readily available commercially, indicates that it may represent an effective implant material for repair of contour defects.

Adult↗
PubMed1984

Silver-impregnated porcine xenografts for treatment of meshed autografts.

Meshing of skin grafts has gained wide acceptance as a means of conserving donor sites in cases of extensive skin loss. In smaller injuries, meshed grafts have the advantage of providing for more efficient wound drainage than unmeshed grafts. Covering widely meshed skin grafts with meshed allografts has been found to result in reductions in infection-related rejection of the allografts. Porcine xenografts have been widely used as temporary wound coverings as they protect the wounds and provide a hospitable environment for reepithelialization. We have used silver-impregnated porcine xenografts to cover meshed skin grafts with excellent results. The porcine xenograft provides a protective wound covering that promotes epithelialization in the interstices of the meshed graft, and the silver ion in the collagen of the xenograft provides an improved means of controlling infection. Three cases are described.

Adult↗
PubMed1984

Rhinophyma: treatment with electrocautery and silver-impregnated porcine xenograft.

A typical case of advanced rhinophyma is reported. Partial excision reduced the size of the nose by two-thirds, leaving a thin layer of dermis. This was covered with silver-impregnated porcine xenograft, which allowed efficient drainage and remained adherent in its initial application for 2 weeks. A total of four applications of silver-impregnated porcine xenografts--the last two involving only very small areas--were required for complete epithelialization at 5 weeks after surgery. We believe that this xenograft is an ideal dressing for wounds resulting from partial excision of rhinophymatous tissue, providing the beneficial effects of biological dressings, including the hemostatic effects of collagen with the added benefit of silver's potent antibacterial properties. Silver-impregnated porcine xenograft reduces patient discomfort and results in rapid healing with excellent cosmetic results.

Aged↗
PubMed1984

The most indolent ulcers of the skin treated with porcine xenografts and silver ions.

Cutaneous ulcers associated with Hansen's disease have long been recognized as among the most indolent of all ulcers. We have successfully treated such ulcers with porcine xenograft, achieving healing in ulcers which had been present for as much as three decades. These results suggest that this regimen may be applicable to other cutaneous ulcers wherever skin is missing. The newly available antibacterial effects of silver-impregnated porcine xenografts should have the result of increasing the effectiveness of the treatment still further.

Anti-Infective Agents, Local↗