1/205. Microvascular reconstruction of the skull base: indications and procedures.PURPOSE: The aim of the current study was to review the use of free tissue transfer for reconstruction of the skull base and for coverage of intracranial contents. patients AND methods: From 1990 until 1996, revascularized flaps were transferred to the skull and the skull base in 11 patients in whom intracranial/extracranial resection of tumors of the skull base was performed in cooperation with the Department of neurosurgery. The defects resulted from removal of squamous cell carcinomas (n = 4), basal cell carcinomas (n = 4), malignant melanoma, malignant schwannoma, and malignant meningioma. Defect repair was accomplished by revascularized transfer of latissimus dorsi muscle flaps in seven cases and rectus abdominis flaps and forearm flaps in two cases each. In five patients with extensive intracranial tumor spread, reconstruction was performed for palliative reasons. RESULTS: A safe soft tissue closure of the intracranial and intradural space was achieved in all patients, whereas the contour of the facial skull and the neurocranium was satisfactorily restored at the same time. By using the entire length of the grafted muscle, the vascular pedicle could be positioned next to the external carotid artery and conveniently connected to the cervical vessels. The mean survival time of the patients with palliative treatment was 8.4 months, with an average duration of hospital stay of 24.5 days. CONCLUSIONS: Despite the increased surgical effort of revascularized tissue transfer, microvascular reconstruction of large skull base defects appears to be justified, even as a palliative measure.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/205. Use of a vertical rectus abdominis myocutaneous flap in bilateral groin dissection for recurrent carcinoma of the penis.We present a 42-year-old man requiring bilateral groin dissection for recurrent squamous cell carcinoma of the penis. Tissue cover was obtained using a pedicled vertical rectus abdominis myocutaneous flap. This case is made interesting by the use of a unilateral flap to cover a large bilateral lower abdominal tissue defect, enabling minimal weakening of the abdominal wall, primary skin closure, and allowing early mobilization and hospital discharge.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
3/205. Reconstruction of full-thickness lower eyelid defects using a blepharoplasty technique with a hard palate mucosal graft.The authors report a method of reconstruction of a full-thickness lower eyelid defect using a blepharoplasty technique utilizing excess skin of the lower eyelid with a hard palate mucosal graft. In all patients the hard palate mucosa took well, and good functional and aesthetic results were obtained. The most suitable indication of this technique might be for the defect occurring horizontally (for which direct closure is difficult to apply) and located in the lateral side of the lower eyelid (when a large amount of excess skin can be utilized). The authors conclude that although the shape and size of the defect to which this method can be applied is restricted, this is a useful option in the reconstructive methods of a full-thickness lower eyelid defect.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
4/205. Multicystic autoimmune thyroiditis-like disease associated with hiv infection. A case report.BACKGROUND: Human immunodeficiency virus (hiv) infection and resulting acquired immunodeficiency syndrome (AIDS) may involve virtually every organ system, including the endocrine glands. Thyroid dysfunction most commonly reflects advanced disease and generally resembles euthyroid sick syndrome. Rarely do opportunistic infections, hemorrhage, neoplasms and drugs account for alterations in thyroid tissue. Multiple lymphoepithelial cysts of parotid gland and thymus have been identified, but similar findings in thyroid gland have not been reported. CASE: A 41-year-old, hiv-seropositive woman, asymptomatic for seven years, developed a squamous cell carcinoma of the cervix with local-regional extension. At the same time, bilateral complex thyroid cysts and high titers of antimicrosomal antibodies (1/6,400) were detected. Ultrasound-guided fine needle aspiration biopsy of the thyroid showed a heterogeneous lymphocytic population with a reactive appearance and occasional groups of epithelial cells with an immature squamous pattern, along with cytologic features of autoimmune thyroiditis. Immunocytochemistry was positive for CD20, CD3 and CD5. Immunoglobulin heavy chain gene rearrangement by polymerase chain reaction from cytologic material showed a polyclonal lymphoid population. External radiotherapy resulted in a significant reduction in the pelvic lesion. Four months after diagnosis, abdominal ultrasound displayed multiple hepatic metastasis, the patient's condition rapidly deteriorated, and she died about a month later. CONCLUSION: This case had unique features and probably represented an AIDS-related lesion and distinct entity.- - - - - - - - - - ranking = 0.43031787586236keywords = drug (Clic here for more details about this article) |
5/205. Vulval squamous cell carcinoma arising in chronic hidradenitis suppurativa.hidradenitis suppurativa is a chronic inflammatory disease of the sweat glands and hair follicles which is rarely associated with squamous cell carcinoma (SCC). A case of vulval SCC complicating hidradenitis suppurativa is presented. In addition to being the first case to report the association of vulval SCC and hidradenitis suppurativa in the English language literature, it also illustrates the difficulty inherent in distinguishing between invasive SCC and pseudoepitheliomatous hyperplasia on histological examination. The success of wide local excision of the vulval lesion and primary closure without recourse to skin grafts, rotational flaps, or healing by secondary intention is demonstrated.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
6/205. Closure of an oropharyngocutaneous fistula in an irradiated patient. A case report.A case of oropharyngocutaneous fistula is presented in a preoperatively irradiated patient. A double-layer closure, using a modified Owens flap, was used to obtain a satisfactory result.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
7/205. A staff dialogue on a socially distanced patient: psychosocial issues faced by patients, their families, and caregivers.Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The following case of an hiv-positive woman who was diagnosed with cervical cancer during a twin pregnancy was discussed at the May, 1999 Schwartz Center Rounds. The patient was in drug rehabilitation having been dependent on crack cocaine, with a past history of syphilis and gonorrhea. She was single and her other children were in foster care. Initially she was suspicious and non-compliant. A plan was negotiated to biopsy the cervical lesion after cesarean section and with confirmation of malignancy she underwent radical surgery and subsequently radiotherapy. Despite the almost insurmountable social and educational distance between her and her caregivers, they managed to bond and facilitate care. Although there were compromises with which staff were uncomfortable, the relationship was maintained and continues.- - - - - - - - - - ranking = 0.43031787586236keywords = drug (Clic here for more details about this article) |
8/205. Delayed type hypersensitivity to intralesional triamcinolone acetonide.Corticosteroids are the most widely used class of drugs in dermatology. In the past, allergic contact dermatitis to topical corticosteriods was rarely reported. In this article, we present a case of delayed type hypersensitivity to triamcinolone acetonide.- - - - - - - - - - ranking = 0.43031787586236keywords = drug (Clic here for more details about this article) |
9/205. Closure of hemicorporectomy with bilateral subtotal thigh flaps.Hemicorporectomy is typically performed with a circumferential truncal incision, and the wound is closed primarily. Wound disruption is a common complication, especially at the base of the wound closure and posteriorly at the lumbar vertebral level. We report a case of the use of bilateral subtotal thigh flaps for the closure of a hemicorporectomy wound in a patient with a defect extending up to the high lumbar region. The subtotal thigh flap is a well-vascularized thick flap that provides a firm support for the abdominal viscera and is a large flap that can be used to close even a high lumbar defect.- - - - - - - - - - ranking = 2keywords = closure (Clic here for more details about this article) |
10/205. perfusion therapy for skin cancer.Surgical techniques for the selective administration of anti-cancer drugs is presented. These isolated-perfusion or intra-arterial infusion procedures have achieved significant palliation for many patients with advanced cancer. When used in conjunction with surgical excision of certain early skin cancers, such as aggressive forms of malignant melanoma of the extremities, improved cure rates may be achieved.- - - - - - - - - - ranking = 0.43031787586236keywords = drug (Clic here for more details about this article) |
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