Biomedical subjects
Publications and source records attributed to D A Ellis.
Outstanding or protruding ears are relatively common in the pediatric otolaryngology population. We propose a method of otoplasty that is simple to use and provides safe and predictable results. The technique of otoplasty is outlined in detail with emphasis on creation of a desired antehelical fold with the use of modified Mustarde sutures as well as modifications of the lobule and the need for conchal set-back.
The contribution of disseminated Mycobacterium avium complex (DMAC) infection to the morbidity and mortality of patients with acquired immune deficiency syndrome (AIDS) is unclear. Previous studies that suggested the decreased survival of patients with AIDS and DMAC had incomplete information on patient immunologic status and follow-up. We studied patients with AIDS and DMAC and compared their survival with that of AIDS patients without DMAC but with other comparable risk factors for survival. Case and control subjects were similar in terms of CD4 cell count, prior AIDS status, history of antiretroviral therapy, history of Pneumocystis carinii prophylaxis, and year of diagnosis. A group of 39 patients with untreated DMAC had significantly shorter survival, mean of 5.6 +/- 1.1 months (median 4 months), than 39 matched patients with AIDS but without DMAC, mean 10.8 +/- 1.3 months (median 11 months, p less than 0.0001). The survival of 16 additional patients with DMAC who received antimycobacterial therapy, mean of 9.5 +/- 1.4 months (median 8 months), was not significantly shorter than that of an additional 16 matched control subjects, mean 11.7 +/- 1.9 months (median 11 months, p = 0.58). Patients with treated DMAC survived significantly longer than those with untreated DMAC (p less than 0.01). We conclude that untreated DMAC significantly shortens survival. Moreover, these results indicate that patients with DMAC who receive antimycobacterial therapy do not experience the shortened survival seen in untreated DMAC.
Local anesthesia and conscious sedation are important aspects of facial plastic surgery. The safe and effective application of these techniques is important to produce happy, satisfied patients as well as good surgical results. Local anesthetic and sedative drugs will be discussed with respect to their mechanisms of action, doses, toxicities and appropriate selection. We will discuss the techniques we have developed using fentanyl and Versed and our evaluation of their effectiveness. Twenty sequential facial plastic surgical patients undergoing a total of 30 procedures will be reviewed. The average dose of fentanyl was 70 mcg and Versed was 3.1 mg. Significant amnesia occurred in 60% of patients, 80% experienced little or no discomfort and 90% would have no hesitation to undergo another procedure with similar anesthesia and sedation.
The crooked nose is defined as a nose in which the midline is off center without tissue loss. This leaves a nose that is angulated at the nasion or the rhinion. Surgical correction with angulation of the nasion includes medial osteotomies, two transverse oblique osteotomies, one transverse root osteotomy and one lateral osteotomy. Angulation at the rhinion includes separation of one upper lateral cartilage from the septum, shortening of one upper lateral cartilage, weakening of the dorsal strut with a double cut technique and resuturing the upper lateral cartilage septal complex back together.
During a study of genital infection in inner-city family-planning patients we examined 452 women for Chlamydia trachomatis. The prevalence of infection was 7.3%. There was no significant difference between patients attending because of genital symptoms and those who were attending for routine family-planning advice. Infection was found to be correlated with five main demographic parameters; age less than 25, no stable partnership, hormonal contraception, nulliparity and West Indian Ethnic origin. Using these parameters a simple scoring system was devised which allowed a high-risk population to be defined in whom screening would be economically justified.
In this paper we have reviewed cutaneous wound closure in facial plastic and reconstructive surgery using two different tissue adhesives: (1) Fibrin glue (Tisseel), and (2) N-butyl-2-Cyanoacrylate (Histoacryl Blue). Fibrin glue was used on 23 patients: eight lower blepharoplasties, eight hemi-facelifts, five mid browlifts and seven facial reconstructive procedures. Histoacryl glue was used in 108 blepharoplasty incisions, 30 facelift incisions, 21 submental incisions for liposuction, and 19 local flaps for facial reconstructive procedures. Comparison was made of the adequacy of bonding, cosmetic result of the incision, ease of use and cost. The results of our experience with tissue adhesives indicate the use of fibrin glue mainly on the undersurface of flaps. We think histoacryl glue is the ideal tissue adhesive for surface cutaneous wound closure in regards to safety, reliability, tensile strength and cost effectiveness.
Sixty patients, ranging in age from 29 to 74 years, were studied for the effect of animation of the upper half of the face on the aging features. Patients were divided into three categories according to the dominant behavioral pattern: brow lifters, frowners, and squinters. Brow ptosis was accentuated laterally in the squinters and medially in the frowners. The brow-lifter group showed more uniform displacement of the eyebrow. The coarse wrinkles or the animation lines also correlated well with the animation pattern. These patterns are acquired in childhood and remain subconsciously in effect throughout adult life and therefore have a significant effect on brow ptosis.
Fibrin glue has gained extensive use in Europe in the past decade but remains fairly new to North America. Fibrin glue physiology, its historical background, experimental findings, its present uses and the question of safety are addressed. Results of its use in facial plastic and reconstructive surgery at the Toronto Western Hospital are presented. The authors conclude that fibrin glue is a safe bioadhesive and sealant. It is an excellent adjunct but not a substitute for good surgical techniques.
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Twenty eight patients with bronchial carcinoma were studied before pneumonectomy. Measurement of spirometric indices, static lung volumes, transfer factor (TLCO), and transfer coefficient (KCO) was undertaken before and four months after pneumonectomy. Fourteen of the patients also performed a symptom limited progressive exercise test on a cycle ergometer before and four months after pneumonectomy. All patients had standard xenon-133 ventilation and technetium-99m perfusion scans performed before operation. Eleven patients had krypton-81m ventilation scans in addition. Significant correlations were seen between changes in FEV1, TLCO and KCO and the preoperative function of the resected lung as determined by percentage preoperative perfusion to that lung (p less than 0.001). There were mean decreases in FEV1 of 22% and in vital capacity (VC) of 28.7% predicted. Estimation of postoperative FEV1 from the preoperative values showed equally good agreement with measured postoperative values whether 99mTc perfusion or 81mKr ventilation scans were used in the 11 patients in whom both scans were available. Significant correlations were seen between change in maximum exercise ventilation (VEmax) or maximum oxygen uptake (VO2max) after pneumonectomy and percentage preoperative perfusion to the resected lung (p less than 0.001). Estimation of postoperative maximum ventilation and maximum oxygen uptake from the postoperative values on the basis of 99mTc perfusion scans showed good agreement with observed values. Perfusion scans are useful in estimating not only the changes in spirometric indices that follow pneumonectomy for bronchial carcinoma but also changes in carbon monoxide transfer and exercise capacity.
Non-linear scar revision techniques involve levelling facial skin. Classification as to the nature of the pitting allows the surgeon to select techniques to improve the facial cosmetic appearance. The types of intradermal pitting and subcutaneous atrophy along with nodular scarring produce the lack of levelling and the depression that the patients want corrected. The useful modalities available to level facial skin are dermal levelling, injectable substances, dermal punch grafting, excision and facelifting. The selection of these techniques is dependent on the above classification and the patient's desire for improvement.
There are many types of alar base excisions. However, analysis of the nostril circumference into the columella, nostril sill, and the alar flare (the ovoid subset of the alar base esthetic unit) is critical in assessing the location and amount of circumference reduction in alar base excisions.
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Facial aging is a dynamic process which continues throughout adult life. Individuals are affected to a variable degree depending on facial motor habits, exposure and susceptibility to damaging ultraviolet radiation, smoking, and the microscopic tissue changes inherent to the aging process. Aside from avoiding smoking and utilizing sunscreens and other solar protection, there is little that can be done to prevent or retard the development of these changes. There is, however, a vast array of corrective procedures which may be utilized in a planned, sequential fashion to deal with age-related deformities as they occur.
Although uncommon, meconium peritonitis can present with a scrotal mass. Usually calcified, this mass may be the initial or only sign of meconium peritonitis. We detected such a scrotal mass prenatally with ultrasound.