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Biomedical subjects

S Asko-Seljavaara

Publications and source records attributed to S Asko-Seljavaara.

At least 73 records · Page 4Linked to original sources
PubMed1995

Return of sensibility and final outcome of breast reconstructions using free transverse rectus abdominis musculocutaneous flaps.

Thirty-nine patients who had had free transverse rectus abdominis musculocutaneous (TRAM) flaps were studied and interviewed 5 months to 2.3 years after the procedure. The main reason why the patients had wanted the reconstruction in the first place was difficulty with the external prosthesis. Thirty three of 39 would have had the operation again; three were hesitant, and three had regrets for reasons other than that the breast was not satisfactory. All patients considered that the symmetry of the breasts was good or satisfactory with bras; without bras, one patient thought that the symmetry was poor, and the physician thought that the symmetry was poor in nine patients. Two-point discrimination turned out to be too delicate for studying the sensitivity of the breast. When pressure sensitivity was studied with von Frey monofilaments, the threshold values were significantly lower on the lateral and medial side and under the reconstructed breast than on the opposite side. In 22 patients the lateral part, and in 23 the medial part, of the reconstructed breast was insensate. There was good or satisfactory pressure sensitivity on the lateral side in nine patients and on the medial side in eight. The return of sensitivity to the autogenous breast reconstruction was variable among the patients studied, but it did not affect their satisfaction with the reconstruction.

Abdominal Muscles↗
PubMed1995

Temporal artery island flap in reconstruction of the eyelid.

The temporal artery island flap, based on the anterior branch of the superficial temporal artery, was used in full thickness eyelid reconstructions of 11 patients (in four for both lids, in two for the upper lid and in five for extensive lower lid defects). The skin island was taken from the upper lateral frontal skin in front of the hairline to leave minimal scaring and create a long vascular pedicle. Mucosal or chondromucosal graft was used for the inner lining. In seven patients the arterial pedicle surrounded by a 0.5 cm wide band of subcutaneous tissue containing the corresponding veins, was tunnelled under the skin in a one stage procedure. In four cases, the pedicle was temporarily left above the skin to shorten the operating time. The temporal artery island flap is a reliable way of reconstructing both lids, or the lower lid in cases where the local flaps have been used in earlier operations. Because of the risk of bulging and for functional reasons, we do not recommend the flap for upper eyelid reconstructions.

Adenocarcinoma↗
PubMed1994

Mouse subrenal capsule assay chemosensitivity and DNA flow cytometry parameters of human melanoma metastases.

Chemosensitivity was analyzed by mouse subrenal capsule assay (SRCA) in 103 human melanoma metastases 79 of which were also analyzed by DNA flow cytometry. The most effective combination was dacarbazine, vincristine, and carmustine (DOB), followed by cisplatin plus etoposide (Plat-VP16). By the original criteria of the assay, 35% of tumors were sensitive to DOB treatment while 15% responded to Plat-VP16. Chemosensitivity of DNA diploid and aneuploid tumors showed no significant difference; 35% of the aneuploid tumors were sensitive to DOB and 19% to Plat-VP16, whereas 41% and 13% respectively of the diploid tumors were sensitive. An association between DNA index and chemosensitivity was observed. Growth of the implant was observed in 44% of tumors with a DNA index above 1.5 receiving DOB treatment, whereas only 12% of tumors with an aneuploid DNA index < or = 1.5 grew. No significant difference was observed in the SPF of chemotherapy sensitive and insensitive tumors, though a tendency to lower SPF was observed in sensitive tumors.

Adult↗
PubMed1993

Cutaneous blood flow in the free TRAM flap.

According to clinical studies there are fewer circulatory complications with the free TRAM flap than with the pedicled TRAM flap. In this haemodynamic study, we measured perioperative cutaneous blood flow in 11 free TRAM flaps with laser Doppler flowmetry (LDF) and transcutaneous oxygen tension (ptcO2). We also studied 4 pedicled TRAM flaps with an additional microvascular anastomosis. Our results suggest that skin blood flow in the free TRAM flap is superior compared to our previously presented results of the pedicled TRAM flaps, and also superior to pedicled TRAM flaps with additional microvascular anastomoses of the inferior epigastric vessels to "supercharge" them.

Adult↗
PubMed1993

Latissimus dorsi breast reconstruction. Long term results and return of sensibility.

The long-term results of 44 patients who underwent breast reconstruction after mastectomy with latissimus dorsi musculocutaneous flaps with endoprostheses were studied. Good symmetry without a brassiere was achieved in 15 patients, slight asymmetry in 24 and poor symmetry in five (11%). Symmetry when a brassiere was worn was acceptable in all but one of the patients (43/44). A third of the patients (n = 13) had developed unacceptable (grade III or IV) capsular contraction, but 39 (89%) of the patients studied were satisfied with the long-term reconstruction. Cutaneous sensibility, measured by von Frey's test, had returned to 28 (64%) of the cutaneous skin islands, to their medial parts in particular. The flaps in patients who had received concentrated radiation or who had large prostheses remained numb. Sensation was normal in the scars of the donor areas in all but three patients. Latissimus dorsi breast reconstruction with an endoprosthesis is safe and simple. It gives a subjectively satisfactory result in nine out of 10 patients and is therefore a valuable method of reconstruction after mastectomy.

Cicatrix↗
PubMed1993

Use of the Ilizarov technique after a free microvascular muscle flap transplantation in massive trauma of the lower leg.

The use of microvascular flaps has become routine in treating compound tibial fractures with extensive soft-tissue loss. Vascularized bone grafts, or shortening of the leg and later elongation with the Ilizarov technique, have been advocated if the injury involves major bone loss. The authors treated four of these massive injuries by debridement and external fixation with the leg at its normal length. Acute free flap reconstructions (four latissimus dorsi, and one case added with a vascularized iliac crest graft) were performed. Tibial corticotomy was later made above or below the defect (varying from 2.5 to 7 cm) and the bone was corrected with slow (0.5-0.75 mm/day) segmental distraction. This was combined with elongation of the leg in two cases. The consolidation time after corticotomy ranged from nine to 12 weeks. The healing time of the fracture after the initial injury was 12, 14, 22, and 36 months, respectively. In massive injury of the lower leg, maintain the initial length of the leg, and perform early free muscle flap reconstruction and segmental bone distraction under the free flap.

Adult↗
PubMed1992

Tumour growth rate and DNA flow cytometry parameters as prognostic factors in metastatic melanoma.

The prognostic value of flow cytometric parameters and tumour growth rate of melanoma metastases under the mouse renal capsule was investigated for tumours from 117 consecutive patients referred to the Helsinki University Central Hospital Melanoma Team. DNA flow cytometry (FCM) was interpretable for the tumours of 114 patients, and growth rate analysis for 82 patients, both results being available from 79 patients. Thirty-six percent of the tumours were DNA diploid and 64% DNA aneuploid. Tumour ploidy and S-phase fraction were shown by multivariate Cox model analysis to be independent prognostic variables and major determinants of survival after first recurrence. Patients with DNA diploid or aneuploid tumours survived a median 16 and 27 months, respectively. A high growth rate of tumour sample in vivo under the mouse renal capsule tended to be a sign of poor prognosis, although not reaching statistical significance. Combining the results of FCM, tumour growth rate and TNM stage, we propose a highly efficient prognostic scoring method. Patients with a score above 0.75 had a median survival of 11 months compared to 30 months among patients scoring under 0.75 (P less than 0.0001). This score was the most significant (P less than 0.0001) prognostic factor in the Cox model when TNM stage, age, ploidy, SPF, and tumour growth rate were analysed as covariates.

Adult↗
PubMed1992

Reconstruction of the Achilles tendon region by free microvascular flaps. 9 cases followed for 1-9 years.

In 1981-89, 9 patients underwent reconstruction for complex injuries in the Achilles tendon region. 10 free microvascular flaps were used: 5 fasciocutaneous and 5 muscle or musculocutaneous flaps. In addition, 4 Achilles tendons and 1 tibial posterior nerve were reconstructed, 1 femoropopliteal bypass was performed, and 6 tibial fractures were treated. The patients were re-examined on an average 3.5 years after the reconstruction. The stability of soft tissues was good in all patients. Good contour was achieved in superficial defects with fasciocutaneous and in deep injuries with latissimus dorsi free flaps. The calcaneal tendon function was good in 5, fair in 2 and poor in 2 patients, depending on the severity of the underlying skeletal injury. We conclude that free microvascular transfer offers one-stage reconstruction of complex, infected wounds in the Achilles tendon region, promotes fracture healing, and allows simultaneous tendon or nerve repair.

Achilles Tendon↗
PubMed1991

DNA ploidy pattern and S-phase characteristics of metastatic melanoma.

Samples of 130 metastatic melanomas from 92 patients were analyzed by DNA flow cytometry. DNA aneuploidy was observed in 67% of the patients. DNA indices were evenly distributed from 0.6 to 2.6 Tumors originating from primary lesions in the lower extremities were more frequently DNA aneuploid than those of other sites. S-phase fraction (SPF) was evaluable from 73 tumors. DNA aneuploid tumors had a significantly higher SPF than diploid tumors, and females had a higher SPF than males. Furthermore, distant metastases had a higher SPF than metastases in regional lymph nodes and in transit metastases, probably indicating a higher growth potential in metastases spreading to distant sites.

Aneuploidy↗
PubMed1991

DNA aneuploidy and low S-phase fraction as favourable prognostic signs in metastatic melanoma.

The prognostic value of cellular DNA content in melanoma metastases was investigated by flow cytometric analysis of fresh or paraffin-embedded tumour blocks from 95 consecutive patients referred to the Helsinki University Central Hospital Melanoma Team. Thirty-three per cent of the tumours were DNA diploid and 67% DNA aneuploid. S-phase fractions were lower in DNA diploid than in DNA aneuploid tumours (10.7% and 17.6%). Tumour ploidy and S-phase fraction were shown by multivariate Cox model analysis to be independent prognostic variables and major determinants of survival after first recurrence. Surprisingly, patients with DNA aneuploid tumours and with tumours with low SPF survived significantly longer than those with DNA diploid or high SPF tumours. This exceptional finding of favourable prognosis for DNA aneuploid tumours was more prominent among patients receiving intensive systemic therapy and among patients with stage IV disease, probably indicating a tendency for DNA aneuploid tumours to have higher sensitivity to systemic therapy.

Adult↗
PubMed1991

The return of sensitivity to cold, warmth and pain from excessive heat in free microvascular flaps.

Recovery of sensitivity to cold, warmth and pain caused by excessive heat in various types of free microvascular flaps was studied psychophysically in 27 patients who had undergone such operations four months to four years earlier. A thermal stimulator based on the Peltier principle and controlled by a microprocessor was used to measure the sensitivity to temperature in the transplants. The results were compared with the measured thresholds in the opposite sites in corresponding normal body areas. The present study showed that sensitivity to cold, warmth, and pain caused by excessive heat did return to some free microvascular flaps. According to the measurements the sensation started to return after 6 months in some flaps, and all types of thermal stimuli were felt by one patient as early as 10 months after operation. The return was more pronounced in younger people and in smaller flaps. If the hands, feet, or head defects were reconstructed with a thin skin flap (posterior aspect of thigh, dorsum of foot, or subscapular) the recovery of sensitivity was verified. Sensation returned to the musculocutaneous and osteomusculocutaneous transfers if they were on the hands or the head, or if they were sutured to healthy tissue with normal sensation. The main advantage of the psychophysical sensory testing method that we used is that it gave exact numerical data that made it possible to compare results among the different patient groups and even those obtained at different clinics and laboratories.

Adolescent↗
PubMed1990

Anti-melanoma antibodies bind preferentially to diploid metastases in immunoscintigraphy.

Immunoscintigraphy with 99Tcm-labelled anti-melanoma monoclonal antibody F(ab')2- fragments was performed in 23 patients with histologically verified metastatic melanoma. Immunoscintigraphy was positive in 14 patients and all known metastases were detected in eight patients, five of whom had only one lesion. Lesion localization and detectability were as follows: 12/13 (92%) cutaneous and subcutaneous, 11/14 (79%) lymph node, 5/7 (71%) bone, 3/6 (50%) lung and 1/5 (20%) abdominal metastases were visualized. Despite its high specificity--no false positive immunoscintigrams--the low sensitivity of this method in detecting deep metastases hampers its usability. The false negative results were not due to lack of antigen expression as positive immunostaining results were observed also in specimens from patients with negative immunoscintigrams. Flow cytometric analysis of the metastases revealed that in 7/8 (88%) patients with diploid tumours had positive immunoscintigrams but only 7/15 (47%) patients with aneuploid tumours. These results show that the diagnostic accuracy of melanoma immunoscintigraphy can be improved by selecting patients not only by testing for the antigen but also on the basis of DNA analysis of an accessible lesion.

Abdominal Neoplasms↗
PubMed1990

Suitability of the scapular flap for reconstructions of the foot.

Eighteen patients with mainly a traumatic soft-tissue defect of the foot underwent reconstruction with a microvascular free scapular flap. Of the 17 successful transfers, 13 were to the weight-bearing parts of the foot. The stability and contour of the flaps were assessed after an average follow-up time of 3 years (range 1 to 5 years). The thicknesses of the scapular donor site and flap and the recipient site were measured by an ultrasound technique. The resistance of the flap to shear was measured with a dynamometer. The ultrasound measurements aided in refining our operative technique. In early cases, the flap thickness after transfer could be more than double what it was in the donor area. With proper tightening, the thickness could be reduced, with improvement in contour but no increase in soft-tissue stability or shear resistance of the flap. Without proper tightening, the scapular flap tended to be redundant when transferred to the foot. For good results, the patient should be lean, since the optimal thickness of the scapular donor site was less than 6 mm and the maximum thickness should not exceed 8 to 10 mm. The differences in shear resistance between the flaps were not associated with the soft-tissue stability of the reconstruction. The relative laxity of the flap on the plantar surface was found by several patients to be subjectively unpleasant. Although good contour could be achieved when covering the plantar heel, the tendency of the flap to develop abrasions and superficial breakdowns made it unsatisfactory for covering this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗