Amitabha Mitra - Academia.edu (original) (raw)
Papers by Amitabha Mitra
Clinical and diagnostic laboratory immunology, 1998
The synovial membrane in osteoarthritis (OA) often exhibits inflammatory infiltrates, but the rol... more The synovial membrane in osteoarthritis (OA) often exhibits inflammatory infiltrates, but the role of T cells in these infiltrates is not known. T-cell activation antigens were analyzed by immunohistochemistry, and T-cell cytokine transcripts were measured by competitive PCR in synovial membranes from patients with OA and rheumatoid arthritis (RA). Lymphoid cell aggregates, containing primarily CD3+ T lymphocytes, were found in 65% of patients with OA. Mononuclear cells expressing the activation antigens CD69, CD25, CD38, CD43, CD45RO, and HLA class II were present in both patient groups, although in higher numbers in patients with RA. Interleukin 2 (IL-2) transcripts were found in 10 of 18 patients with OA versus 12 of 13 patients with RA (P = 0.03). Gamma interferon (IFN-gamma) transcripts were detected in 9 of 18 patients with OA versus 10 of 13 patients with RA (not significant), whereas IL-10 transcripts were found in nearly all patients. IL-4 and IL-5 were not detected in any ...
Annals of Vascular Surgery, 1990
In patients with tissue necrosis, higher limb salvage rates can be accomplished with free tissue ... more In patients with tissue necrosis, higher limb salvage rates can be accomplished with free tissue transfers performed by a vascular and plastic surgeon team. We treated 10 patients with severe ischemic soft tissue defects in their legs with radical debridement and free tissue transfer alone (two patients) or after revascularization (eight patients). Arteriography was performed to plan revascularization to evaluate bypass results, and to identify appropriate recipient vessels for free tissue transfer. Soft tissue defects treated with free tissue transfer included nonhealing amputation sites in five patients and proximal skin and muscle necrosis in the remaining patients, one of which resulted in an exposed in-situ graft in one leg. One patient underwent a distal bypass specifically to provide arterial inflow for free tissue transfer, whereas seven other patients received free tissue transfers following bypass due to persistently nonhealing wounds. The remaining two patients had diabetes mellitus with necrosis near a major joint with nonhealing amputation sites. Free tissue transfers were taken from the latissimus dorsi in six patients, and from the gracilis, rectus abdominis, rectus femoris, and scapula flaps in other patients. Recipient vessels for free tissue transfers were the external lilac artery (one patient), saphenous vein bypass grafts (two patients), popliteal artery (one patient), posterior tibial (three patients), and dorsalis pedis vessels (three patients). Eight of the 10 flaps were viable at follow-up (four months-six years), with a mean follow-up of 20 months. One patient underwent above-knee amputation 15 months after operation and one underwent below-knee amputation three years later due to central flap necrosis. The remainder achieved functional limb salvage allowing patients to resume ambulation. Vascular surgeons should consider free tissue transfer in patients with nonhealing soft tissue defects following optimal revascularization to further extend our ability to salvage the threatened limb.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 1989
There is the possibility that a correlation exists between enriching the capillary density and ac... more There is the possibility that a correlation exists between enriching the capillary density and accelerating the wound healing process. Since nicotinamide has been shown to be a stimulator of the angiogenic process, we decided to investigate its ability to enhance skin flap survival in a rat model. Secondly, we attempted to determine an optimal dose.
HAND, 2007
Introduction The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBW... more Introduction The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBWCD, Boehringer Laboratories, Norristown, PA), a new device for delayed primary closure of fasciotomy wounds. Materials and Methods A retrospective review was performed over a period of 36 months of all patients with an upper extremity fasciotomy that could not be closed primarily. Cases that underwent fasciotomy closure with the SBWCD were separated from the patients that had a split thickness skin graft (STSG). Results Seven patients had their wound closed with the SBWCD within 10 days (mean of 7.4 days). The seven patients that underwent STSG had their wound closed in an average of 8.4 days. The average number of days between the day of the fasciotomy incision and the date of the placement of the SBWCD was 1.9 days. STSGs were placed on the fasciotomy wounds on an average of 10.3 days after the date of the fasciotomy incision. We found that the SBWCD allowed for starting to approximate the edges of the fasciotomy wound at an earlier time when compare to STSG (2.1 vs 10.3 days). Conclusions We feel that the SBWCD as a one-stage procedure provides a consistent and efficacious way to manage upper extremity fasciotomy wounds while minimizing the morbidity associated with STSG. Elimination of a secondstage procedure reduces hospital costs. Our findings may help to inform surgeons about an available alternative when an upper extremity fasciotomy wound is not amenable to primary closure.
Plastic and Reconstructive Surgery, 2011
The most common clinical presentation of thoracic outlet syndrome stems from compression of the l... more The most common clinical presentation of thoracic outlet syndrome stems from compression of the lower trunk of the brachial plexus or ulnar nerve. A plethora of anatomical variations have been implicated in the cause of thoracic outlet syndrome. Roos' identification and classification of scalene muscle and fibrous bands have added an additional dimension to understanding its cause and subsequent treatment. Understanding the anatomy and relationship of this band with the lower trunk of the brachial plexus is of paramount importance. As part of the authors' long-term study of the type 3 band in relation to the brachial plexus, 70 embalmed cadavers were dissected to yield 100 first thoracic ribs. Fibrous bands, when present, were studied in relation to the brachial plexus. A fibrous band consistent with Roos' type 3 was identified and found to occur in 35 percent of first ribs and 41 percent of cadavers. The mean size was 3.45 × 0.27 cm. Origins and insertions are described. Contrary to Roos' own description, however, the authors observed that Roos' type 3 band was anterior to the T1 nerve root, creating a tunnel through which the T1 nerve root must pass before joining the C8 nerve root. The authors believe that the type 3 band, when present, can create a tunnel that compresses the…
Journal of Oral and Maxillofacial Surgery, 1993
A retrospective study was carried out on eight consecutively treated children, 2 to 14 years of a... more A retrospective study was carried out on eight consecutively treated children, 2 to 14 years of age, seven with toxic epidermal necrolysis and one with transitionaltype Stevens-Johnson syndrome. The body surfaces affected ranged from 40% to 100%. Seven of the patients were taking a sulfonamide or anticonvulsant before the onset of their disease. Complete reepithelialization took an average of 15 days, but newly evolving lesions of the lips and oropharynx continued for approximately 4 more weeks. These lesions took an additional 2 to 4 weeks to heal. Only one of the children died.
The Journal of Foot and Ankle Surgery, 2014
Journal of Burn Care & Rehabilitation, 1993
Six pediatric patients with lower-extremity excoriated autografts secondary to pruritus were trea... more Six pediatric patients with lower-extremity excoriated autografts secondary to pruritus were treated randomly. Group 1 was treated with application of an Unna Boot that was changed every 7 days; Group 2 was treated with conventional dressing and antihistamines. Average time for complete wound closure was similar in the two groups: 32 days for group 1 versus 36 days for group 2. Treatment of group 1 cost 19.80/wkcomparedwith19.80/wk compared with 19.80/wkcomparedwith30.90/wk for treatment of group 2. The time for dressing change was 15 min/wk for group 1 and 3.5 hr/wk for group 2. The parents in group 1 gave their children better scores when asked about appetite, sleep, and play patterns.
Journal of Burn Care & Rehabilitation, 1994
A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. C... more A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. Children were divided into three groups: (group 1) no surgery and no splint (n = 21), (group 2) nonsurgical management with splint appliance (n = 8), and (group 3) commissuroplasty (n = 9). Mean age was 3 years, and minimum follow-up was 1 year. Subjective evaluation of standard photographs was performed by six surgeons. Group 2 had a less noticeable scar and more normal lip parameters. Group 3 and group 1 had similar percent scar involvement and overall poor subjective scores. All evaluators felt that commissuroplasty (group 3) improved patients' appearance compared with no surgery and no splint (group 1). Therefore the application of our easily constructed splint alone yielded the best cosmetic results.
Annals of Plastic Surgery, 1994
There is general agreement that Dupuytren's contracture is a genetic disorder that occurs pr... more There is general agreement that Dupuytren's contracture is a genetic disorder that occurs predominantly in white men of Northern European ancestry. It appears rarely in the purely black population. We present our experience from Temple University of 8 black patients ...
CHEST Journal, 2005
The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conserva... more The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conservative treatments such as debridement and antibiotic irrigation routinely fail, and patient survival rates are low. Literature has indicated that flap procedures often provide better treatment. In the present article, we report our experience utilizing pectoralis major muscle flaps, occasionally coupled with latissimus dorsi, rectus abdominis, and/or serratus anterior flaps, to wrap infected grafts and fill dead space. Between 1990 and 2004, 10 patients were brought to our attention with infections of prosthetic grafts of the great vessels (7 men and 3 women; mean age, 53 years). Infections in nine patients involved an ascending aortic graft, while one patient had an infected pulmonary artery graft. Following diagnosis and exploration, an initial debridement is performed, followed by 48 h of antibiotic irrigation. A definitive muscle flap procedure is then utilized to fill dead space and clear the infection, followed by an appropriate antibiotic regimen. The infections in all 10 patients were cleared using the muscle flap procedure. Two patients required a tapered-dose regimen of oral steroids, one of whom also required a secondary flap procedure due to the advanced stage of infection. Two other patients later died due to unrelated complications; however, autopsies revealed that operative sites had healed successfully. Patients were followed up for a period of 2 months to 2 years, and recurrence was not found. Our outcomes suggest that muscle flap procedures, specifically utilizing the pectoralis major and regional muscles, should be kept in mind in the management of life-threatening infections of aortic grafts. Due to the limited number of patients in this study, we feel more research with a larger volume of cases is warranted.
Plastic and Reconstructive Surgery, 2005
Civilian gunshot wounds to the hand are typically caused by low-velocity weapons, which create a ... more Civilian gunshot wounds to the hand are typically caused by low-velocity weapons, which create a localized pattern of soft-tissue and bone injury that usually allows for early definitive treatment. A retrospective chart review of 72 patients treated for 98 gunshot wound fractures at an urban level I trauma center was conducted to evaluate the results of limited debridement and early definitive fracture fixation of urban gunshot wound fractures of the hand. The incidence of hand fractures, means of fracture fixation, number of operations, occurrence of infection, and level of patient compliance were determined. Twenty-nine fractures were managed definitively with reduction and splinting in the emergency department or intensive care unit. Sixty-eight fractures were treated surgically, at a mean of 2 days after injury. Eleven patients required more than one operation. The overall infection rate was 8 percent and was not influenced by the fracture fixation method. All infections were superficial and resolved with antibiotics alone. Thirty-nine percent of patients were lost to follow-up after hospital discharge and 85 percent of patients were lost to follow-up before documented fracture healing. Twenty-six percent of patients were lost to follow-up with a removable fixation device in place. Limited debridement and early definitive fracture fixation are associated with low rates of complications for typical civilian handgun wound fractures. Cases with extensive injury or contamination do require a staged approach to treatment. Poor patient compliance in the urban trauma setting should be expected and may affect the management plan.
Clinical and diagnostic laboratory immunology, 1998
The synovial membrane in osteoarthritis (OA) often exhibits inflammatory infiltrates, but the rol... more The synovial membrane in osteoarthritis (OA) often exhibits inflammatory infiltrates, but the role of T cells in these infiltrates is not known. T-cell activation antigens were analyzed by immunohistochemistry, and T-cell cytokine transcripts were measured by competitive PCR in synovial membranes from patients with OA and rheumatoid arthritis (RA). Lymphoid cell aggregates, containing primarily CD3+ T lymphocytes, were found in 65% of patients with OA. Mononuclear cells expressing the activation antigens CD69, CD25, CD38, CD43, CD45RO, and HLA class II were present in both patient groups, although in higher numbers in patients with RA. Interleukin 2 (IL-2) transcripts were found in 10 of 18 patients with OA versus 12 of 13 patients with RA (P = 0.03). Gamma interferon (IFN-gamma) transcripts were detected in 9 of 18 patients with OA versus 10 of 13 patients with RA (not significant), whereas IL-10 transcripts were found in nearly all patients. IL-4 and IL-5 were not detected in any ...
Annals of Vascular Surgery, 1990
In patients with tissue necrosis, higher limb salvage rates can be accomplished with free tissue ... more In patients with tissue necrosis, higher limb salvage rates can be accomplished with free tissue transfers performed by a vascular and plastic surgeon team. We treated 10 patients with severe ischemic soft tissue defects in their legs with radical debridement and free tissue transfer alone (two patients) or after revascularization (eight patients). Arteriography was performed to plan revascularization to evaluate bypass results, and to identify appropriate recipient vessels for free tissue transfer. Soft tissue defects treated with free tissue transfer included nonhealing amputation sites in five patients and proximal skin and muscle necrosis in the remaining patients, one of which resulted in an exposed in-situ graft in one leg. One patient underwent a distal bypass specifically to provide arterial inflow for free tissue transfer, whereas seven other patients received free tissue transfers following bypass due to persistently nonhealing wounds. The remaining two patients had diabetes mellitus with necrosis near a major joint with nonhealing amputation sites. Free tissue transfers were taken from the latissimus dorsi in six patients, and from the gracilis, rectus abdominis, rectus femoris, and scapula flaps in other patients. Recipient vessels for free tissue transfers were the external lilac artery (one patient), saphenous vein bypass grafts (two patients), popliteal artery (one patient), posterior tibial (three patients), and dorsalis pedis vessels (three patients). Eight of the 10 flaps were viable at follow-up (four months-six years), with a mean follow-up of 20 months. One patient underwent above-knee amputation 15 months after operation and one underwent below-knee amputation three years later due to central flap necrosis. The remainder achieved functional limb salvage allowing patients to resume ambulation. Vascular surgeons should consider free tissue transfer in patients with nonhealing soft tissue defects following optimal revascularization to further extend our ability to salvage the threatened limb.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 1989
There is the possibility that a correlation exists between enriching the capillary density and ac... more There is the possibility that a correlation exists between enriching the capillary density and accelerating the wound healing process. Since nicotinamide has been shown to be a stimulator of the angiogenic process, we decided to investigate its ability to enhance skin flap survival in a rat model. Secondly, we attempted to determine an optimal dose.
HAND, 2007
Introduction The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBW... more Introduction The purpose of this paper is to evaluate the Silver Bullet Wound Closure Device (SBWCD, Boehringer Laboratories, Norristown, PA), a new device for delayed primary closure of fasciotomy wounds. Materials and Methods A retrospective review was performed over a period of 36 months of all patients with an upper extremity fasciotomy that could not be closed primarily. Cases that underwent fasciotomy closure with the SBWCD were separated from the patients that had a split thickness skin graft (STSG). Results Seven patients had their wound closed with the SBWCD within 10 days (mean of 7.4 days). The seven patients that underwent STSG had their wound closed in an average of 8.4 days. The average number of days between the day of the fasciotomy incision and the date of the placement of the SBWCD was 1.9 days. STSGs were placed on the fasciotomy wounds on an average of 10.3 days after the date of the fasciotomy incision. We found that the SBWCD allowed for starting to approximate the edges of the fasciotomy wound at an earlier time when compare to STSG (2.1 vs 10.3 days). Conclusions We feel that the SBWCD as a one-stage procedure provides a consistent and efficacious way to manage upper extremity fasciotomy wounds while minimizing the morbidity associated with STSG. Elimination of a secondstage procedure reduces hospital costs. Our findings may help to inform surgeons about an available alternative when an upper extremity fasciotomy wound is not amenable to primary closure.
Plastic and Reconstructive Surgery, 2011
The most common clinical presentation of thoracic outlet syndrome stems from compression of the l... more The most common clinical presentation of thoracic outlet syndrome stems from compression of the lower trunk of the brachial plexus or ulnar nerve. A plethora of anatomical variations have been implicated in the cause of thoracic outlet syndrome. Roos' identification and classification of scalene muscle and fibrous bands have added an additional dimension to understanding its cause and subsequent treatment. Understanding the anatomy and relationship of this band with the lower trunk of the brachial plexus is of paramount importance. As part of the authors' long-term study of the type 3 band in relation to the brachial plexus, 70 embalmed cadavers were dissected to yield 100 first thoracic ribs. Fibrous bands, when present, were studied in relation to the brachial plexus. A fibrous band consistent with Roos' type 3 was identified and found to occur in 35 percent of first ribs and 41 percent of cadavers. The mean size was 3.45 × 0.27 cm. Origins and insertions are described. Contrary to Roos' own description, however, the authors observed that Roos' type 3 band was anterior to the T1 nerve root, creating a tunnel through which the T1 nerve root must pass before joining the C8 nerve root. The authors believe that the type 3 band, when present, can create a tunnel that compresses the…
Journal of Oral and Maxillofacial Surgery, 1993
A retrospective study was carried out on eight consecutively treated children, 2 to 14 years of a... more A retrospective study was carried out on eight consecutively treated children, 2 to 14 years of age, seven with toxic epidermal necrolysis and one with transitionaltype Stevens-Johnson syndrome. The body surfaces affected ranged from 40% to 100%. Seven of the patients were taking a sulfonamide or anticonvulsant before the onset of their disease. Complete reepithelialization took an average of 15 days, but newly evolving lesions of the lips and oropharynx continued for approximately 4 more weeks. These lesions took an additional 2 to 4 weeks to heal. Only one of the children died.
The Journal of Foot and Ankle Surgery, 2014
Journal of Burn Care & Rehabilitation, 1993
Six pediatric patients with lower-extremity excoriated autografts secondary to pruritus were trea... more Six pediatric patients with lower-extremity excoriated autografts secondary to pruritus were treated randomly. Group 1 was treated with application of an Unna Boot that was changed every 7 days; Group 2 was treated with conventional dressing and antihistamines. Average time for complete wound closure was similar in the two groups: 32 days for group 1 versus 36 days for group 2. Treatment of group 1 cost 19.80/wkcomparedwith19.80/wk compared with 19.80/wkcomparedwith30.90/wk for treatment of group 2. The time for dressing change was 15 min/wk for group 1 and 3.5 hr/wk for group 2. The parents in group 1 gave their children better scores when asked about appetite, sleep, and play patterns.
Journal of Burn Care & Rehabilitation, 1994
A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. C... more A retrospective analysis of 29 patients who sustained perioral electrical burns was undertaken. Children were divided into three groups: (group 1) no surgery and no splint (n = 21), (group 2) nonsurgical management with splint appliance (n = 8), and (group 3) commissuroplasty (n = 9). Mean age was 3 years, and minimum follow-up was 1 year. Subjective evaluation of standard photographs was performed by six surgeons. Group 2 had a less noticeable scar and more normal lip parameters. Group 3 and group 1 had similar percent scar involvement and overall poor subjective scores. All evaluators felt that commissuroplasty (group 3) improved patients' appearance compared with no surgery and no splint (group 1). Therefore the application of our easily constructed splint alone yielded the best cosmetic results.
Annals of Plastic Surgery, 1994
There is general agreement that Dupuytren's contracture is a genetic disorder that occurs pr... more There is general agreement that Dupuytren's contracture is a genetic disorder that occurs predominantly in white men of Northern European ancestry. It appears rarely in the purely black population. We present our experience from Temple University of 8 black patients ...
CHEST Journal, 2005
The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conserva... more The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conservative treatments such as debridement and antibiotic irrigation routinely fail, and patient survival rates are low. Literature has indicated that flap procedures often provide better treatment. In the present article, we report our experience utilizing pectoralis major muscle flaps, occasionally coupled with latissimus dorsi, rectus abdominis, and/or serratus anterior flaps, to wrap infected grafts and fill dead space. Between 1990 and 2004, 10 patients were brought to our attention with infections of prosthetic grafts of the great vessels (7 men and 3 women; mean age, 53 years). Infections in nine patients involved an ascending aortic graft, while one patient had an infected pulmonary artery graft. Following diagnosis and exploration, an initial debridement is performed, followed by 48 h of antibiotic irrigation. A definitive muscle flap procedure is then utilized to fill dead space and clear the infection, followed by an appropriate antibiotic regimen. The infections in all 10 patients were cleared using the muscle flap procedure. Two patients required a tapered-dose regimen of oral steroids, one of whom also required a secondary flap procedure due to the advanced stage of infection. Two other patients later died due to unrelated complications; however, autopsies revealed that operative sites had healed successfully. Patients were followed up for a period of 2 months to 2 years, and recurrence was not found. Our outcomes suggest that muscle flap procedures, specifically utilizing the pectoralis major and regional muscles, should be kept in mind in the management of life-threatening infections of aortic grafts. Due to the limited number of patients in this study, we feel more research with a larger volume of cases is warranted.
Plastic and Reconstructive Surgery, 2005
Civilian gunshot wounds to the hand are typically caused by low-velocity weapons, which create a ... more Civilian gunshot wounds to the hand are typically caused by low-velocity weapons, which create a localized pattern of soft-tissue and bone injury that usually allows for early definitive treatment. A retrospective chart review of 72 patients treated for 98 gunshot wound fractures at an urban level I trauma center was conducted to evaluate the results of limited debridement and early definitive fracture fixation of urban gunshot wound fractures of the hand. The incidence of hand fractures, means of fracture fixation, number of operations, occurrence of infection, and level of patient compliance were determined. Twenty-nine fractures were managed definitively with reduction and splinting in the emergency department or intensive care unit. Sixty-eight fractures were treated surgically, at a mean of 2 days after injury. Eleven patients required more than one operation. The overall infection rate was 8 percent and was not influenced by the fracture fixation method. All infections were superficial and resolved with antibiotics alone. Thirty-nine percent of patients were lost to follow-up after hospital discharge and 85 percent of patients were lost to follow-up before documented fracture healing. Twenty-six percent of patients were lost to follow-up with a removable fixation device in place. Limited debridement and early definitive fracture fixation are associated with low rates of complications for typical civilian handgun wound fractures. Cases with extensive injury or contamination do require a staged approach to treatment. Poor patient compliance in the urban trauma setting should be expected and may affect the management plan.