Biomedical subjects
Publications and source records attributed to Andres Bustillo.
The deep plane face-lift is a safe and reliable technique for treatment of the aging face. It affords improvement in the lower face and midface. The use of fibrin glue in the face-lift has improved the healing and recovery of patients.
OBJECTIVES/HYPOTHESIS: Disease-specific quality-of-life (QOL) assessment of patients with nasal valve compromise and symptomatic nasal obstruction has not been studied previously. The objectives of the study were to determine whether surgical treatment of the nasal valve improves disease-specific QOL and to identify clinical or demographic variables predictive of patients' baseline QOL or change in QOL. STUDY DESIGN: Prospective, multi-institutional outcomes study of 20 patients with nasal obstruction and a surgically treatable diagnosis of nasal valve compromise. METHODS: Disease-specific QOL assessment was performed using the Nasal Obstruction Symptom Evaluation (NOSE) scale preoperatively (n = 20) and at 3 (n = 14) and 6 months (n = 20) after surgery. Clinical and demographic data were collected, along with physician-reported assessments of degree of nasal obstruction. RESULTS: Mean NOSE scores significantly improved from baseline to 3 months after surgery (68.9 vs. 20.7 [P < .0001]), from baseline to 6 months after surgery (68.9 vs. 15.8 [P < .0001]), and from 3 to 6 months after surgery (20.7 vs. 15.8 [P = .0077]). Physician assessment of degree of nasal obstruction using a visual analogue scale was significantly correlated with baseline NOSE scores (P = .013) and change in NOSE scores at 6 months (P = .0015). No other clinical or demographic factors were found to be predictive. CONCLUSION: In patients with symptomatic nasal obstruction and nasal valve compromise, surgical repair of the nasal valve improves disease-specific QOL. Physician rating of degree of nasal obstruction was found to be significantly correlated with patient-reported QOL.
OBJECTIVE: Conventional follow-up of surgically and radiotherapy-treated paragangliomas is usually carried out with physical examinations and either magnetic resonance imaging and/or computed tomography. Up to now, octreotide has been reserved for primary diagnosis, for which it has been shown to be a reliable imaging modality. However, the postsurgical and postradiation changes seen on conventional imaging make the diagnosis of small recurrent lesions difficult. We sought to evaluate the role of octreotide scintigraphy in the detection of recurrent paragangliomas. STUDY DESIGN: We based this case series on 3 patients who were found to have recurrent paragangliomas after primary surgical resection. All patients underwent octreotide scintigraphy during routine follow-up. RESULTS: Three patients were found to have recurrent paragangliomas using octreotide scintigraphy. In one of the patients, conventional imaging (magnetic resonance imaging, computed tomography) failed to detect the recurrence. CONCLUSION: The octreotide study was able to detect the small recurrences because octreotide binds directly to receptors on the tumor and is not affected by postsurgical or postradiotherapy changes. The intrinsic resolution of most commercially available gamma cameras is about 1 cm, making it quite sensitive to detect small tumors. Although this patient did not have synchronous lesions, octreotide scintigraphy can also aide in the detection of such lesions.
In this report, we discuss indications, technique, outcome, and complications of revision single-stage laryngotracheal reconstruction (SSLTR), formulate guidelines to avoid or prevent procedure failure, and establish a protocol for the management of procedure failure. We retrospectively reviewed the charts of 122 patients between the ages of 8 months and 9 years who underwent SSLTR between January 1992 and September 2001 in 2 tertiary care children's medical centers in different cities and assessed the outcomes of patients who underwent revision SSLTR. A total of 122 patients underwent SSLTR, of whom 48 patients underwent anterior and posterior grafting. Of the 122 patients, 13 had revision SSLTR; 8 of these 13 underwent the initial laryngotracheal reconstruction at another institution. Five patients had anterior grafting laryngotracheal reconstruction without stenting, 7 had anterior and posterior grafting with 1 to 21 days of endotracheal intubation, and I had cricotracheal resection and anastomosis. Of the 13 patients, 5 had anterior wall or graft collapse (grade IV stenosis), 4 had subglottic stenosis (grade IV), 2 had circumferential subglottic stenosis (grade III), and 2 had subglottic and glottic stenosis (grade IV). The overall success rate for all patients was 86% (105 of 122). The success rates for the 122 patients were as follows: anterior grafting, 100%; anterior and posterior grafting, 83% (40 of 48); and revision cases, 70% (9 of 13). We conclude that laryngotracheal reconstruction with a costal cartilage rib graft should be considered the procedure of choice for the management of subglottic stenosis. We believe that patients in whom the first procedure fails should have a high chance of success with revision SSLTR if strict guidelines and protocols are followed.
OBJECTIVES: We sought to determine the thromboprophylactic effects of low-molecular-weight heparin (LMWH) and pentoxifylline. DESIGN: Randomized blinded study. Materials and methods Sixty Sprague-Dawley rats were assigned to 1 of 4 treatment groups: (1) control group (n = 15), (2) pentoxifylline group (n = 15), (3) LMWH group (n = 15), and (4) combined therapy group (n = 15). A groin/abdominal free flap was elevated in each, with division of the artery and microvascular repair The animals received therapy for 4 days preoperatively and 6 days postoperatively. Flaps were monitored visually, and on the seventh postoperative day, the flap was elevated, and the microvascular anastomosis was assessed for patency. RESULTS: There was a statistically significant improvement in arterial patency in both pentoxifylline and LMWH groups compared with controls (P < 0.01) but no significant improvement with combined therapy (P > 0.05). CONCLUSIONS: In this animal model, LMWH and pentoxifylline have significant thrombroprophylactic effects when used individually but not in combination.
Orbital infection has long been the most common complication of sinusitis. In light of our increased knowledge of sinusitis, improved diagnostic tools, and new pharmacologic and surgical treatments, we investigated whether trends in diagnosis and treatment are changing. We reviewed the charts of all 43 patients who had been referred to our institution with orbital complications of sinusitis between Jan. 1, 1985, and Dec. 31, 1999. Nine of the 43 patients had been diagnosed between Jan. 1, 1985, and Dec. 31, 1990 (mean: 1.5 patients/yr) and 34 had been diagnosed between Jan. 1, 1991, and Dec. 31, 1999 (mean: 3.8 patients/yr). Of the 43 patients, 27 had cellulitis and 16 had an abscess (one of the 16 had two abscesses--one subperiosteal and one supraorbital). All 17 abscesses were treated surgically. Five of the 7 abscesses operated on from 1985 through 1990 were treated via an open external approach, whereas 7 of the 10 abscesses that were operated on later were treated via an endoscopic approach. We conclude that orbital complications of sinonasal origin are being recognized more frequently than they were in the past and that endoscopy has supplanted the open external approach as the preferred method of drainage.
The extended columellar strut-tip graft is a structural unit used in endonasal rhinoplasty that combines the attributes of the columellar strut and the tip graft. It is used to provide projection and contour to the nasal tip. Our goal with this study was to evaluate a 15-year experience with 155 patients who underwent rhinoplasty with the extended columellar strut-tip graft. Of these, 110 underwent secondary rhinoplasty, and 45 underwent primary rhinoplasty. There were 6 patients in the secondary rhinoplasty group who experienced complications: in 3, the graft became visible postoperatively, and 3 patients had graft placement asymmetry. These 6 patients underwent surgery in the initial years of graft development. One patient with graft edge visibility and 1 patient with graft asymmetry underwent revision surgery with satisfactory results. The extended columella strut-tip graft is a reliable method to provide nasal tip projection and contour. The successful use of the graft requires precise diagnosis and surgical technique.