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Biomedical subjects

W T Lawrence

Publications and source records attributed to W T Lawrence.

At least 19 recordsLinked to original sources
PubMed1992

The nasolabial rhomboid flap.

Nasolabial flaps are frequently used for reconstruction of nasal and midfacial defects. The donor site and the quality of the skin provided are excellent, though reconstructive results are sometimes hampered by a dog-ear at the base of the flap. Properly designed rhomboid flaps generally rotate into position without a dog-ear. By combining the nasolabial donor site with the rhomboid design, the advantages of both methods of reconstruction can be combined. Nasolabial rhomboid flaps have been used successfully in seven patients. Reconstructions in all instances have been of high quality, and no revisions have been required after at least 6 months of follow-up. The nasolabial rhomboid flap is a refinement of existing techniques that can maximize the aesthetic quality of midfacial reconstructions.

Facial Neoplasms↗
PubMed1992

The safety and effect of topically applied recombinant basic fibroblast growth factor on the healing of chronic pressure sores.

The first randomized, blinded, placebo-controlled human trials of recombinant basic fibroblast growth factor (bFGF) for pressure sore treatment were performed. Three different concentrations of bFGF in five dosing schedules were tested for safety using hematology, serum chemistries, urinalysis, absorption, antibody formation, and signs of toxicity. Efficacy was evaluated by wound volumes, histology, and photography. No toxicity, significant serum absorption, or antibody formation occurred. In six of eight subgroups, there was a trend toward efficacy with bFGF treatment. When all subgroups were combined, comparison of the slopes of the regression curves of volume decrease over initial pressure sore volume demonstrated a greater healing effect for the bFGF-treated patients (p < 0.05). Histologically, bFGF-treated wound sections demonstrated increased fibroblasts and capillaries. More patients treated with bFGF achieved > 70% wound closure (p < 0.05). Blinded observers were able to distinguish differences in visual wound improvement between bFGF and placebo groups. These data suggest that bFGF may be effective in the treatment of chronic wounds.

Administration, Topical↗
PubMed1992

Long-term follow-up of women treated with perurethral Teflon injections for stress incontinence.

The perurethral injection of Teflon has been advocated as a simple, economical and effective treatment of stress incontinence in women. We have reviewed patients treated by this technique in Nottingham. Improvement in their symptoms fell from 80% immediately after operation to 27% at follow-up 3 years later. Because of the disappointing long-term results we have abandoned this procedure for the treatment of stress incontinence.

Adult↗
PubMed1991

In search of the optimal treatment of keloids: report of a series and a review of the literature.

The optimal treatment for keloids remains undefined. A randomized, prospective study was performed comparing two treatment regimens that were believed promising. One regimen consisted of surgery plus two preoperative and three postoperative intralesional injections of triamcinolone, whereas the other regimen consisted of surgery plus oral colchicine (1.2 mg per day) initiated 3 weeks after surgery and continued for 5 months. The study was compromised by limited acceptance of the experimental protocol, though many patients were willing to accept one of the regimens on a nonprotocol basis. Data from protocol and nonprotocol patients were pooled to allow for an adequate number of patients for analysis. Minimum follow-up required for inclusion in the analysis was 1 year. A total of 27 keloids in 16 patients were treated with surgery and adjunctive triamcinolone, and 28 keloids in 20 patients were treated with surgery and postoperative colchicine. Fifty (91%) of the keloids were on the ear. There were no significant differences between the two treatment groups in terms of sex, race, age, keloid location, keloid size, the duration the keloid was present, and the percentage of keloids that were recurrent. Only 8 (30%) of the keloids treated with surgery and perioperative triamcinolone were cured, whereas 9 (32%) of the keloids treated with surgery and postoperative colchicine did not recur. There was no significant difference between the two regimens.

Humans↗
PubMed1991

Deformity correction and long-term survival in an infant with iniencephaly. Case report.

The authors describe the case of a male infant who was diagnosed prenatally as having iniencephaly. Since birth, the child has grown, thrived, and undergone two successful operations to correct his cervical deformity. This case demonstrates that the iniencephaly defect is not uniformly fatal and that neurosurgical intervention may offer significant improvement in the cervical deformity.

Abnormalities, Multiple↗
PubMed1989

Oestrogen dosage in prostatic cancer: the threshold effect?

We present the results of a prospective randomised trial of Estradurin, a long-acting oestrogen preparation (polyoestradiol phosphate), 160 mg per month, compared with bilateral orchiectomy in patients with advanced prostatic carcinoma (T3M1; T4MO/M1). The dose was lower than that usually recommended to induce a consistent fall in serial plasma testosterone levels to within the castrate range. Most patients treated with oestrogen showed an initial clinical and biochemical response equal to that obtained for patients undergoing orchiectomy. The inevitable relapse in hormone sensitivity sometimes occurred very soon after the start of oestrogen treatment. Many patients had poorly suppressed plasma testosterone expressed as a mean of monthly serial measurements, but then responded to secondary orchiectomy. These data only suggest that, in the treatment of hormone-sensitive prostatic carcinoma, it may be necessary to reduce plasma testosterone to midway between castrate and normal ranges. The data support the theory that response to androgen withdrawal is qualitative rather than quantative. The effective dose of oestrogen may therefore be reduced and the risk of thrombo-embolic complications minimised.

Delayed-Action Preparations↗
PubMed1989

Congenital muscular torticollis: a spectrum of pathology.

Congenital muscular torticollis (CMT) is a disorder characterized by a shortening of at least one of the cervical muscles and tilting of the head to the opposite side. The most commonly affected muscle is the sternocleidomastoid (SCM) muscle. An unusual case is presented here: a CMT patient with involvement of the trapezius muscle in addition to the SCM muscle who has recently been treated at North Carolina Memorial Hospital. This patient still has a slight residual deformity despite two surgical procedures, physical therapy, and splinting. A review of 41 CMT patients who presented to this institution from 1952 to the present demonstrates that the disorder is extremely variable in terms of severity of deformity and response to various types of therapy. The condition will resolve spontaneously in the majority of patients by the age of 1 year, and if the condition has not resolved by then, it is unlikely to do so without surgery. We therefore believe that surgery should be postponed until after 1 year of age. Most of the patients requiring surgery are effectively treated by division of the involved muscle in at least one area with or without lengthening of the SCM muscle. Splinting and physical therapy are recommended postoperatively. A few patients such as the unusual one with involvement of the trapezius muscle resist our most aggressive therapeutic efforts.

Female↗
PubMed1988

Liposuction on a lymphedematous arm.

Suction lipectomy is a technique that is being used more and more frequently for both aesthetic and reconstructive purposes. One area in which this technique has only seen limited use heretofore is in the treatment of acquired lymphedema. A patient with longstanding postmastectomy lymphedema recently presented with a large squamous cell carcinoma and multiple smaller suspicious lesions on the lymphedematous forearm. After resection of these lesions, the remaining forearm skin was treated with liposuction to debulk the arm and facilitate wound closure. Most of the forearm wound could be closed after this treatment. The upper arm was then debulked with liposuction as well. Redundant skin from the upper arm was resected and used as a skin graft to the residual defect on the forearm. All wounds healed primarily. The patient has shown no sign of recurrence and has greatly improved function of the arm at 10 months follow-up. Although its exact indications and limitations need to be defined, liposuction can be a useful treatment modality for at least some patients with acquired lymphedema.

Aged↗
PubMed1988

Urological abnormalities in young women with severe constipation.

Anorectal and urodynamic studies were carried out in 10 young women with severe constipation and the results compared with those obtained in controls. The lowest volumes that provoked a desire to defecate (constipated 200 +/- 50 v controls 110 +/- 10 [mean +/- SEM] ml: p less than 0.05), and a desire to micturate (constipated 560 +/- 40 v controls 295 +/- 15 [mean +/- SEM] ml: p less than 0.001), were significantly greater in constipated patients compared with controls. The maximum tolerable rectal volume (380 +/- 30 v 290 +/- 20 [mean +/- SEM] ml: p less than 0.05) and the bladder capacity (720 +/- 50 v 540 +/- 10 [mean +/- SEM] ml: p less than 0.001) were also increased in the constipated subjects compared with controls. Electromyographic studies show failure of relaxation of the external anal sphincter (EAS) on attempted defecation in all 10 patients; and eight of these patients actually contracted their EAS when they strained to defecate, causing a functional outlet obstruction. Urodynamic studies showed normal urinary flow rates, normal detrusor pressures and normal radiology during voiding. Thus, these studies suggest that constipated patients have an increase in capacity and a reduction in sensitivity in the urinary bladder as well as in the rectum, but showed no evidence of obstruction to urine flow.

Adult↗
PubMed1988

Treatment of urethral stricture disease by internal urethrotomy followed by intermittent 'low-friction' self-catheterization: preliminary communication.

The aim of this study was to determine whether the natural course of urethral stricture disease could be modified following urethrotomy by teaching patients intermittent self-catheterization. Preliminary results in 42 patients show that postoperative urine flow rates can be maintained if this method of 'low-friction' catheterization is adopted. The technique has been well received by an elderly group of patients and can be recommended for wider use.

Adult↗
PubMed1988

Complications of primary palatoplasty: a twenty-one-year review.

The complications of 196 patients who underwent primary palatoplasties at North Carolina Memorial Hospital between 1963 and 1983 were reviewed. The von Langenbeck technique was utilized in 50 percent of the patients, the Wardill-Kilner technique in 45 percent, and the Dorrance technique in 5 percent. Intravelar veloplasties were performed in 34 percent of the patients. The incidence of postoperative complications was: deaths, 0 percent; malignant hyperthermia, 0 percent; aborted procedures, 0.5 percent; feeding difficulties, 0.5 percent; aspiration, 0.5 percent; reexploration for bleeding, 0.5 percent; pneumonia, 1 percent; upper respiratory tract infections, 2 percent; postoperative airway difficulties, 3 percent; oropharyngeal infections, 4 percent; and otitis media, 10 percent. Later evaluations demonstrated problems with otitis media in 17 percent of the patients and fistulas in 6 percent. An additional palatal operation of some type was later required in 22 percent of the patients, with 18 percent of the patients requiring a pharyngeal flap. Intravelar veloplasties were associated with a decreased incidence of secondary pharyngeal flaps but also an increased transfusion requirement. The Wardill-Kilner technique was associated with a higher incidence of postoperative fistulas, and the use of perioperative antibiotics was associated with fewer postoperative fistulas.

Adolescent↗
PubMed1987

Wound healing in sarcoma-bearing rats: tumor effects on cutaneous and deep wounds.

Many surgeons think that cancer causes a higher incidence of wound complications. Wound healing was examined in a cutaneous and deep model in control and sarcoma-bearing rats to evaluate this concept. In a dorsal incisional wound, a significant decrease in wound breaking strength was observed from 19 days after tumor implantation onward. The amount of the breaking strength deficit increased with the size of tumor and the day post-tumor implant. In a deeper wound chamber, hydroxyproline levels, 3H-thymidine incorporation into DNA, histology, and collagen types were examined, and tumor produced no significant change in any parameter. The presence of tumor appeared to inhibit wound healing in cutaneous wounds but had no apparent effect on deeper wounds. This difference in healing in the two wound models is important to surgical oncologists. Because there is no demonstrable tumor-induced healing deficit in deep wounds, cancer-bearing organisms probably still heal these wounds normally.

Animals↗
PubMed1987

Ureteric stone surgery in practice.

From 1983 to 1986 140 patients underwent surgery for ureteric calculus. In approximately 30% "blind" basket extraction was considered appropriate and continued to be effective. Increasing expertise with the rigid ureterorenoscope led to a considerable reduction in open ureterolithotomy (15% in 1985-86), the majority following failed ureteroscopic extraction. In the same year both "blind" basket extraction and ureteroscopy were successful in 82 and 86% of attempts respectively. Electrohydraulic and ultrasonic lithotripsy were used in 12 patients to reduce large impacted calculi. The commonest complication of ureteroscopic stone surgery was perforation; this occurred in 14% of cases, though it was usually trivial and near the vesicoureteric junction. Perforations higher in the ureter tended to follow endoscopic lithotripsy and were often associated with urinary extravasation. Extra-ureteric stone fragments were also occasionally observed in such cases. There were no serious sequelae, although the in-patient stay was prolonged beyond the 48 h customary for uncomplicated extraction. The results suggest that ureteroscopic stone extraction, which can be conveniently introduced into urological practice, should become a standard endoscopic procedure.

Endoscopy↗
PubMed1986

The tolerance of skin grafts to postoperative radiation therapy in patients with soft-tissue sarcoma.

During the last ten years at the National Cancer Institute, 11 patients have received 12 courses of postoperative adjuvant radiation therapy to skin grafts used for wound closure after the resection of soft-tissue sarcomas. The intervals between grafting and the initiation of radiation ranged between 3 and 20 weeks, and 4 patients received chemotherapy at the same time as their radiation. Ten of the 12 irradiated grafts remained intact after the completion of therapy. One graft had several small persistently ulcerated areas that required no further surgical treatment, and one graft required a musculocutaneous flap for reconstruction of a persistent large ulcer. Acute radiation effects on the grafted skin sometimes developed at slightly lower doses than usually seen with normal skin, but these acute effects necessitated a break in therapy on only five occasions. Concurrent chemotherapy and a relatively short interval between grafting and the initiation of radiation seemed to contribute to more severe radiation reactions. This experience indicates that postoperative adjuvant radiation therapy can be delivered to skin grafted areas without undue fear of complications, especially if the graft is allowed to heal adequately prior to initiating therapy and if chemotherapy is not given in conjunction with radiation.

Adolescent↗