Biomedical subjects

William W Dzwierzynski

Publications and source records attributed to William W Dzwierzynski.

7 recordsLinked to original sources

PubMed2006

Prevention of an additional surgery for regional lymphadenectomy in melanoma: rapid intraoperative immunostaining of sentinel lymph node imprint smears.

BACKGROUND: Sentinel lymph node (SLN) biopsy is performed at many institutions and is considered a standard of care in the management of cutaneous melanoma. The discriminatory immunostaining pattern with the 'MCW Melanoma Cocktail' (a mixture of MART-1 {1:500}, Melan- A {1:100}, and Tyrosinase {1:50} monoclonal antibodies) allows intraoperative immunocytochemical evaluation of imprint smears of SLNs for melanoma metastases. Cohesive cells of benign capsular melanocytic nevi that were also immunoreactive with the cocktail do not exfoliate easily for imprint smear detection. METHODS: We prospectively evaluated 73 lymph nodes (70 SLN & 3 non-SLN) from 41 cases (mean 1.8, 1 to 4 SLNs/case) of cutaneous melanoma using a rapid 17-minute immunostaining previously published protocol. The results were compared with permanent sections also immunostained with 'the cocktail'. RESULTS: 19.5%, 8/41 cases (12%, 9/73 lymph nodes) were positive for melanoma metastases on permanent sections immunostained with the 'MCW melanoma cocktail'. Melanoma metastases in 87.5% (7/8) of these cases were also detected in rapidly immunostained imprint smears, with 100% specificity and 90% sensitivity. None of the 7 SLNs from 7 cases with capsular nevi showed false positive results. CONCLUSION: Melanoma metastases could be detected in imprint smears immunostained with 'MCW Melanoma Cocktail' utilizing a rapid intraoperative protocol. The cohesive cells of the capsular nevi do not readily exfoliate and do not lead to false positive interpretation. In a majority of positive cases, a regional lymphadenectomy could have been completed during the same surgery for SLN biopsy and wide excision of primary melanoma site, potentially eliminating the need for an additional surgery.

Journal Article↗

PubMed2006

Sonographic differentiation of digital tendon rupture from adhesive scarring after primary surgical repair.

PURPOSE: After the surgical repair of finger tendons finger range of motion may be limited by tendon rupture or adhesive scarring. Differentiating tendon rupture from adhesive scarring may be difficult clinically. Digital tendon sonography allows the evaluation of tendon integrity in a dynamic setting. Our objective was to determine if sonography could differentiate tendon rupture from adhesive scarring in patients who have had primary tendon repair. METHODS: A retrospective review was performed of the radiographic, clinical, and surgical records of patients referred for finger sonography over a 2-year period. Twenty-eight digits in 21 patients were evaluated for finger tendon disruption after primary surgical repair. The diagnosis of complete tendon rupture was made when 1 or more of the following was identified: a gap separating the proximal and distal tendon margins, visualization of only the proximal tendon margin, or visualization of only the distal tendon margin. Adhesive scarring was diagnosed if the tendon appeared intact with abnormal peritendinous soft tissue abutting or partially encasing the tendon, with synovial sheath thickening, or with restricted tendon motion during dynamic evaluation. RESULTS: Sonography correctly identified tendon rupture or adhesive scarring in 27 of 28 digits with 1 false-positive case (sensitivity, 100%; specificity, 93%; positive-predictive value, 93%; negative-predictive value, 100%; accuracy, 96%). CONCLUSIONS: Sonography is an accurate modality for differentiating tendon rupture from adhesive scarring in patients with prior surgical tendon repair. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic, Level I.

Adolescent↗

PubMed2005

Functional improvement with digital prosthesis use after multiple digit amputations.

PURPOSE: Patients who sustain traumatic amputation of multiple fingers suffer both a functional and psychologic loss. Previous studies of prosthesis use for finger amputees have focused primarily on the psychologic benefits. Clinically our group noticed a functional improvement on hand function tests when patients with multiple digit amputations used a prosthesis. Given the expense of multiple finger prostheses we sought to determine if they led to a consistent functional improvement in these patients. METHODS: Ten consecutive patients performed a battery of hand function tests and rated their ability to perform a variety of activities of daily living both with and without their prosthesis using the Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS: Our results show a significant improvement in 3-finger-pinch strength and grip strength and a trend of improvement of tip-pinch, lateral-pinch, and grip strength in dynamometer positions 1, 2, 3, and 4 in these patients when tested with and without their prostheses. Function in activities of daily living, as assessed by the Disabilities of the Arm, Shoulder, and Hand questionnaire, was improved globally with prosthesis use. In addition, significant improvement was noted in several specific activities including opening a jar, writing, and turning a key, among others. CONCLUSIONS: These results show that prosthesis use provides a functional benefit to these patients in multiple activities.

Activities of Daily Living↗

PubMed2004

Optimization of an immunostaining protocol for the rapid intraoperative evaluation of melanoma sentinel lymph node imprint smears with the 'MCW melanoma cocktail'

BACKGROUND: In the management of cutaneous melanoma, it is desirable to complete the regional lymphadenectomy during the initial surgical procedure for wide excision of biopsy site and sentinel lymph node (SLN) biopsy. In this study, we optimized and evaluated a rapid 17 minutes immunostaining protocol. The discriminatory immunostaining pattern associated with the 'MCW Melanoma Cocktail' (mixture of Melan- A, MART- 1, and tyrosinase) facilitated the feasibility of intraoperative evaluation of imprint smears of SLNs for melanoma metastases. METHODS: Imprint smears of 51 lymph nodes from 25 cases (48 SLNs and 3 non-SLNs, 1 to 4 SLNs/case) of cutaneous melanoma were evaluated. RESULTS: Sixteen percent, 8/51 lymph nodes (28%, 7/25 cases) were positive for melanoma metastases in immunostained permanent sections with the 'MCW melanoma cocktail'. All of these melanoma metastases, except 1 SLN from 1 case, were also detected in rapidly immunostained wet-fixed and air-dried smears (rehydrated in saline and postfixed in alcoholic formalin). The cytomorphology was superior in air-dried smears, which were rehydrated in saline and postfixed in alcoholic formalin. Wet-fixed smears frequently showed air-drying artifacts, which lead to the focal loss of immunostaining. None of the 5 SLNs from 5 cases exhibiting capsular nevi showed a false positive result with immunostained imprint smears. CONCLUSIONS: Melanoma metastases can be detected intraoperatively in both air-dried smears and wet-fixed smears immunostained with the MCW Melanoma cocktail. Air-dried smears rehydrated in saline and postfixed in alcoholic formalin provide superior results and many practical benefits.

Journal Article↗

PubMed2004

Irrigation pressure and vessel injury during microsurgery: a qualitative study.

Irrigation solution is routinely used in microsurgery. While the anticoagulation solution may aid in anastomotic patency, the direct effect of pressure irrigation can have a detrimental effect on the vessel. An experimental study was performed to determine the effect of irrigation pressure on the vessel wall. Histological evaluation with hematoxylin and eosin (H&E) stain and scanning electron microscopy (SEM) was performed on the arteries of New Zealand white rabbits irrigated with lactated Ringer's solution at pressures of 80 mmHg, 100 mmHg, and 500 mmHg. H&E staining and SEM microscopy demonstrated injury to the endothelial cells and internal elastic lamina at pressures of 100 mmHg or greater. Controlling microsurgical irrigation pressure to less than 100 mmHg may help to avoid vessel injury.

Animals↗

PubMed2003

Return to work outcomes after work-related hand trauma: the role of causal attributions.

PURPOSE: This study examined the relationship between workers' judgments of responsibility for their accidents (causal attributions) and work-site avoidance after work-related injuries. METHODS: Ninety-two hand-injured workers referred for psychologic treatment of posttraumatic stress and depressive symptoms were assessed for their beliefs about the cause(s) of their accidents. Causal attributions were obtained before and after psychologic intervention. RESULTS: Workers who blamed coworkers or equipment for their injuries were more likely to resist returning to former work activities than workers who judged themselves responsible for their accidents. In addition those with relatively minor injuries were as much at risk for work-site avoidance as those with more severe injuries. Age, gender, and length of employment with current employer were unrelated to avoidance. CONCLUSIONS: These results suggest the importance of causal attributions as potential predictors of work-site avoidance after traumatic work-related hand injuries, and support the risk for psychologic symptom development after less-severe injuries.

Absenteeism↗

PubMed2002

Psychological impact of traumatic injuries: what the surgeon can do.

In their treatment of accident and assault victims, plastic surgeons have unique opportunities to identify and refer patients with posttraumatic stress symptoms. This article describes brief assessments that surgeons or their clinic staff can use to evaluate traumatically injured adults and children for trauma-related psychological symptoms. An immediate postinjury evaluation (within 10 days of the trauma) consists of 11 questions to determine the presence of the following risk factors for posttrauma maladjustment: panic during or immediately after the trauma, reexperiencing symptoms, avoidance, sleep disturbance, injury from an assault, previous trauma and psychiatric history, and blaming someone else for the injury. The seven follow-up interview questions assess reexperiencing symptoms, avoidance, trauma-related phobias, depression, irritability, and increased substance use, all of which, if present, suggest psychological impairment. Questions recommended for the evaluation of younger children assess changes in play and recreational activity, sleep disturbance, night terror, aggression, irritability, avoidance, emergence of new fears, and loss of recently acquired developmental skills. The assessments require less than 2 minutes and are easily integrated into the hospital or clinic examinations of these patients.

Adolescent↗