Biomedical subjects
Publications and source records attributed to S Medgyesi.
Four cases of muscle-aponeurotic fibroadenomatosis (desmoid) of the abdominal wall are reported. The etiological factors, the recurrence rate, the treatment and the pre- and postoperative examinations are discussed.
We report a case of familial congenital paresis of ramus marginalis nervus facialis in 5 generations. The paresis varied in location, i.e., 2 right-sided and 3 left-sided, 1 side unknown. The primary patient, a 33-year-old female, presented with a complete right-sided congenital lower lip palsy. Electromyographic examination showed absent voluntary activity of the right depressor labii inferior muscle. There was no evidence of denervation of the paretic muscle. These findings may suggest either absence of the depressor labii inferior muscle or possibly absent voluntary activation due to a defect at brainstem level.
Cheilitis granulomatosa in patients with Melkersson-Rosenthal syndrome has proven difficult to treat, and various forms of symptomatic treatment of orofacial swellings have been used with varying success. To evaluate long-term results after surgical reduction cheiloplasty in patients suffering from persistent lip swellings, a follow-up study was performed on 13 patients after 16 years (median). The operations were performed after unsuccessful conservative treatment and regardless of disease activity. Pre- and postoperative medical histories were updated and a clinical examination evaluated the following criteria for a good result: symmetry of the lip, a normalized anterior projection, dimensional harmony between upper and lower lip, no disfiguring cicatrices, and no sensory disturbances. In spite of postoperative disease activity in 6 patients, all 13 patients were satisfied with the long-term result. Clinically, the results in 12 patients were considered good. We therefore recommend lip resection as described when a stationary swelling becomes associated with permanent aesthetic deformity or functional disturbances and conservative measures are unsuccessful.
A method for preparing concentrated fibrinogen for use in autologous fibrin adhesive is described. The adhesive was used in seven patients with eight chronic leg ulcers. The ulcers were divided into two equal sections, and the adhesive was used to seal split-thickness skin grafts in one section, while no adhesive was used to seal the grafts in the other section of the ulcer. The strength of adhesion was measured 3 1/2 minutes after transplantation of a 1-cm2 test split-thickness skin graft. In the sealed grafts, the breaking strength varied from 12 to 26 gm. In the unsealed transplants, the strength was less than 5 gm. The take of the meshed split-thickness skin grafts was equal in the sealed and the unsealed areas, varying from 90 to 100 percent. Biopsies taken on day 7 showed a splitting between graft and recipient bed in half the unsealed grafts; none of the sealed grafts showed splitting, indicating a more stable graft in the sealed areas. Biopsies taken on day 21 showed no difference between sealed and unsealed grafts.
Reconstructive surgery was performed in 18 knee arthroplasties because of wound-healing problems or skin necrosis. The procedure, after debridement, included myocutaneous, muscle flap, and split-skin grafts. Revision was necessary in 6 cases. After 1-17 years, 6 patients had died, 2 had had a low femur amputation, and 5 had had an arthrodesis. Five patients had retained the prosthesis, although 3 of them had considerable pain and poor mobility; only 2 patients were tolerably painfree and had acceptable mobility. Patients with an exposed knee endoprosthesis should be referred to centers with special competence in plastic reconstructive surgery.
Twenty-one cases of congenital absence of the vagina corrected by McIndoe's procedure were examined. The longest follow-up was 21 years (average 10.5 years). Vaginal biopsies showed a spectrum of changes, ranging from an almost normal vaginal mucous membrane to a skin-like mucous membrane. Neither hormonal status nor postoperative complication, nor the time the graft had been in place, correlated to histology, and we suggest that the varied appearance of the graft epithelium depends on the amount of corium included in the transplant.
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A patient with an undetectable meningocele communicating with the lower eyelid is reported. The condition was first suspected during surgical removal of xanthelasmata when liquorrhoea was observed. The diagnosis was confirmed by computer tomography.
A case of solitary lupus miliaris disseminatus faciei simulating a dermoid cyst is reported in a 13-year-old boy. There were no abnormal biochemical parameters. The diagnostic and therapeutic difficulties involved are discussed. This type of tumour is rare in Scandinavia, and presumably carries a good prognosis.
An example of elephantiasis neuromatosa, an unusual variant of neurofibromatosis, coexistent with lipomatosis is presented. This dual cell population produced a diffuse swelling of the gluteal sulcus of a young female. The neurogenous origin of the spindle cell component was substantiated by immunoreactivity for S-100 protein as well as by the fine structural observation of a regular basement membrane coating and a profusion of Luse bodies. As far as can be ascertained, this is the first reported immunohistochemical and ultrastructural study of this particular variant of peripheral nerve sheath lesion.
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A 5 year old girl reported with a congenital lipoma imitating gigantism of a toe. This is a very rare localization of a lipoma.
The results following reconstruction of soft tissue defects in the lower leg in 102 patients with 19 cross-leg flaps, 49 muscle flaps, 17 dorsalis pedis island flaps and 26 free composite island flaps were compared regarding the pattern of primary healing, time taken to heal and costs. The cross-leg flap appeared to be the least dependable method of reconstruction and most expensive way of reestablishing stable soft tissue coverage. Muscle flaps and dorsalis pedis island flaps appeared to be preferable and equal alternatives to cross-leg flaps in the proximal and distal part of the lower leg, respectively. Free composite island flaps also appeared advantageous compared to cross-leg flaps, and seem to be indicated when simpler means of reconstruction are inadequate or would yield a similar result at higher overall costs.
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Four patients with induratio penis plastica, involving the corpus cavernosum, have been treated by excision of the affected tissue and filling of the defect by a transplant of corpus cavernosum bulbi urethrae. Cavernosograms and a histological study indicate that the operative results were good, but the case histories stress the need of extreme care in the selection of patients.
Seven cases of urinary incontinence treated by a free muscle transplant are reported. The incontinence was completely unaffected in 5. One patient was able to work without using diapers, while another albeit completely incontinent, could voluntarily stop the flow after the bladder was filled with water.
Two patients are reported with repeated, nonhealing wounds due to auto-mutilation. The diagnostic and psychiatric problems involved are discussed.