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Biomedical subjects

D L Larson

Publications and source records attributed to D L Larson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Anatomic considerations in transconjunctival blepharoplasty.

To better identify the anatomy of the lower eyelid in relation to the transconjunctival approach to blepharoplasty, 20 fresh cadaver lower eyelids were dissected. Cross-sectional cuts of fresh cadaver specimens also were made and examined by whole-organ photomicrographs of the entire lower eyelid and its associated soft-tissue structures. These were correlated with magnetic resonance imaging studies in the living patient. Measurements were made of the relationship of the lid margin, tarsal plate, infraocular fat (including the three traditional fat compartments), inferior oblique muscle, and eyelid (on stretch). Our findings suggest that a transconjunctival incision closer to the fornix, directed toward the infraorbital rim, allows the surgeon a direct and safe approach to the fat compartments. No distinct anatomic compartmentalization of the periorbital fat as traditionally described was found. There was a consistent extension of the lateral pad, lateral to the lateral canthus of the eye. There are also accumulations of fat outside the orbital septum in the cheek and beneath the orbicularis muscle that contribute to the fullness of the lower eyelid and which cannot be addressed by the transconjunctival approach.

Adipose Tissue↗
PubMed1995

Reconstruction and augmentation patients' reaction to the media coverage of silicone gel-filled implants: anxiety evaluated.

Media coverage tends to focus on sensational aspects. Especially prominent are controversial items related to public health and well-being. This research examined the response by breast-reconstruction and breast-augmentation patients to extensive media coverage regarding silicone gel-filled implants. Results of our survey suggested that media coverage influenced these women. Common concerns expressed by respondents included autoimmune disease, capsular contracture, leakage, increased risk of cancer, and anxiety. All respondents used consultation with their physicians as a primary means of coping with anxiety. Anxiety over media coverage led to some hesitancy concerning use of implants by surveyed patients. Patients who experienced difficulty with their reconstruction noted more anxiety associated with media coverage.

Adaptation, Psychological↗
PubMed1995

Rectus abdominis muscle innervation: implications for TRAM flap elevation.

Sixteen cadaver dissections were performed to identify the location and course of the intercostal nerves in relation to the rectus abdominis muscle. Histochemical staining of fresh nerve biopsies was performed to assess the motor, sensory, and autonomic content of each nerve. Six to eight nerves passed inferomedially between the internal oblique and transversus abdominis muscles before entering the lateral confluence of the anterior and posterior rectus sheath or, in some cases, the posterior rectus sheath proper. The nerves, which contained varying numbers of sensory, motor, and autonomic fibers, passed under the muscle and became intramuscular at varying points along the width of the muscle, with most nerves entering the muscle in the lateral third in direct association with the lateral intercostal vascular pedicle. Two to three nerves entered the lower portion of the muscle below the umbilicus lateral to the inferior epigastric artery. During a partial muscle harvest of the medial two-thirds of the rectus abdominis muscle in these cadavers, it was possible to preserve innervation to the lateral third in several cadavers and to the portion of the rectus muscle lying below the arcuate line in all the cadavers. Innervation to a preserved medial muscle strip could not be preserved. Postoperative electromyographic evaluation of five patients undergoing TRAM flap breast reconstruction using the partial muscle harvest technique demonstrated that the retained lateral strip of muscle can remain innervated but with greatly diminished function, while the lower portion of the retained rectus muscle maintains near-normal function.(ABSTRACT TRUNCATED AT 250 WORDS)

Electromyography↗
PubMed1995

Patient concerns related to media coverage of silicone implants.

Plastic surgical nurses must be aware of the sources of media information their patients are hearing and reading. Television was found to be the most frequent media source of information, and the effect of implant rupture was the most common concern. Plastic surgical nurses are in an excellent position to provide sound scientific information to address fears and anxieties over implant-related issues.

Breast Implants↗
PubMed1995

An historical glimpse of the evolution of rhytidectomy.

Obviously there is much more to be written about the facelift operation than this very brief history. Although it was not intended to be definitive in character, its modest intention was to provide the reader with some of the evolution of the operation and to describe clinical and cadaveric work done over the last two decades as it relates to the aging midface.

History, 20th Century↗
PubMed1994

Long-term effects of radiotherapy administered in childhood for the treatment of malignant diseases.

BACKGROUND: The use of radiotherapy for the treatment of childhood malignancy has improved long-term survival significantly, and many treated children now survive well into adulthood. As a consequence, long-term effects of childhood irradiation are being seen with increasing frequency. METHODS: The medical records of 236 patients who had been treated for malignant disease with radiotherapy during childhood were examined to determine the long-term effect of the radiation on their growth and development. RESULTS: Mean treatment dose was 35.5 Gy; mean age at treatment was 7.2 years; and mean follow-up was 14.5 years. Adjuvant chemotherapy was given to 82%. Some degree of bone deformity (usually with overlying soft-tissue hypoplasia) was seen in 40%; 21% developed some type of endocrine deficiency; 30% developed atrophic skin changes; and 7% developed second malignancies. The incidence of bone deformity and hormonal deficiency increased with the radiation dose; the incidence of second malignancy was independent of dose. Bone deformities were more common when radiation was administered before the age of 2 years. CONCLUSIONS: The consequences of radiotherapy in childhood are significant and must be considered when planning treatment. Even when treatment is essential, families should be informed of the possibility of growth disturbance to prevent subsequent misunderstanding.

Adolescent↗
PubMed1994

Revascularization of free mandibular reconstruction after early emergency arterial ligation.

A 70-year-old man with a squamous cell carcinoma involving the anterior arch and body of the mandible underwent resection and reconstruction with a 10-cm free vascularized iliac crest bone graft, preserving periosteum and minimal adjacent soft tissue. On postoperative day 12, he experienced bleeding from an orocutaneous fistula, requiring emergency ligation of the arterial pedicle to control hemorrhage. After ligation, continued bleeding was noted from the margin of the graft, with active filling of the venous pedicle. The 10-cm mandibular bone graft survived without appreciable resorption during a period of follow-up of 5 years. We believe that bone graft survival in the present case was due to early vascular communication between the periosteum and adjacent soft tissues of the graft with the recipient bed. This mechanism may serve to maintain bone graft viability after early arterial disruption, when repeat arterial anastomosis is believed to be contraindicated.

Aged↗
PubMed1994

The nasolabial fold: a photogrammetric analysis.

The nasolabial fold was analyzed by studying changes with aging in the nasolabial fold and adjacent soft-tissue features. Chronologic photographs were obtained from 19 older subjects, taken approximately every 10 years, from age 20 to their present age. In a separate phase of the study, facial portraits in repose and smiling were taken of young and old adult subjects with a mechanical frame used for setting an objective point of reference. Facial landmarks were identified and depth measurements were made in the anteroposterior direction. Relative lengths of selected points also were determined in the other dimensions (in the coronal plane) from photographs; these distances were normalized by using lower face length (distance from medial canthus to menton) for the vertical orientation and interpupillary distance to normalize horizontal dimensions. It was found that with aging there is anterior, lateral, and inferior displacement of the cheek mass with a resultant deepening of the nasolabial fold, while relationships between the upper lip and the fold itself remain constant. Also with age, the lateral commissure was found to move laterally, while the apparent angle of the nasolabial fold was decreased; this latter dimension was reflected by a decrease in the horizontal component of the fold length. These results support the theory that nasolabial fold deepening with age is caused by changes in the cheek mass and its support.

Adult↗
PubMed1994

The free-fillet flap for reconstruction of the upper extremity.

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wounds. However, in cases of complete extremity amputation, the transfer of pedicled flaps from the amputated part is not possible. In such instances, we have designed free-fillet flaps from the amputated limb to provide wound coverage when replantation of the amputated part was contraindicated. This technique allows immediate wound coverage and preservation of functional amputation stump length, without the morbidity of an additional donor site. We present three cases that demonstrate the utility of this technique as an additional reconstructive option in patients with unreplantable upper-extremity amputations.

Adult↗
PubMed1994

Reconstruction of lower third of face with three simultaneous free flaps.

A case of massive osteoradionecrosis is presented that required angle-to-angle resection of the mandible and replacement of skin of the chin and neck as well as the entire floor of the mouth. In this heavily irradiated patient, three microvascular free flaps were transferred in one operation. A large radial forearm flap was used to reconstruct the floor of the mouth. A second large radial forearm flap was used to reconstruct the chin and neck defects and a fibular osseous flap was used to reconstruct the mandible. All wounds healed primarily. For extremely complicated and large defects, the transfer of multiple free flaps may provide the best reconstruction.

Female↗
PubMed1994

An indirect microimmunofluorescence test for detection of chlamydial antibodies in ovine fetal fluids.

The objective of this study was to evaluate an indirect microimmunofluorescence test (IMIF) for detection of chlamydial antibodies in serum and/or thoracic fluids of aborted ovine fetuses. One hundred eighty-two ovine fetuses, including 64 fetuses from 40 ewes that were experimentally infected with an ovine abortion strain of Chlamydia psittaci at gestation days 90-100, 10 fetuses from 6 normal ewes, and 108 fetuses selected from those received at the Iowa Veterinary Diagnostic Laboratory, were evaluated in this study. Fetuses from experimentally infected ewes were examined 4-60 days after inoculation. The IMIF findings were compared with the results of complement fixation serology for chlamydiae and concentrations of immunoglobulin (IgG). Chlamydiae-specific antibodies were detected by IMIF in 28 of 38 fetuses infected with C. psittaci. Elevated levels of IgG and IMIF titers > or = 1:8 were consistent findings in ovine fetuses infected with chlamydiae for more than 24 days. IgG levels and titers of chlamydial antibodies increased with maturity of the fetus and duration of chlamydial infection. Chlamydial antibodies were not detected with the complement fixation test. Fluids from ovine fetuses aborted as a result of other causes also were examined, and IMIF results were negative. The results of this study indicate that the IMIF is a useful and relatively rapid test for identification of chlamydial antibodies in ovine fetuses.

Abortion, Veterinary↗
PubMed1994

What influences public perceptions of silicone breast implants?

In an effort to determine public attitude regarding breast implants in the wake of what many might consider biased media publicity, surveys of women and men in Milwaukee were made. Questionnaires appropriate to each of four groups [patients with reconstructions (n = 54), mastectomy without reconstruction (n = 14), those with augmentation mammaplasty (n = 26), and the general public (n = 60)] were administered. Some of the findings included the following: Over 98 percent had heard of the controversy; most had received their information from the media, with less than 10 percent referring to a medical journal; only 6 percent felt that the media coverage was objective, while 88 percent felt that the media were biased; almost two-thirds of those in the general population were not aware of any other method of reconstruction; and almost half that same group would have significant hesitancy in having the procedure on themselves or a family member were it indicated. In summary, our findings would substantiate the fact that the media do exert a very significant influence on the public's perception of silicone breast implants. Though most people surveyed generally consider the media biased, they still use them as the primary source for their negative conclusions on the matter. Though the media cannot be viewed as our ally in this matter, we, as a group, might be better served by minimizing conflict, which makes the whole issue less newsworthy.

Attitude to Health↗
PubMed1994

The nasolabial fold: an anatomic and histologic reappraisal.

The nasolabial fold was analyzed by anatomic and histologic evaluation of the tissue planes that create and surround the fold. A fascial-fatty layer exists in the superficial subdermal space extending from the upper lip across the nasolabial fold to the cheek mass. The SMAS is present in the upper lip as the superficial portion of the orbicularis oris muscle. Traction on the SMAS or periosteum lateral to the nasolabial fold can deepen the fold, while traction on the fascial-fatty layer lessens the fold. The fascial-fatty layer and skin of the cheek mass are suggested as the primary ptotic elements responsible for facial aging.

Adipose Tissue↗
PubMed1993

Possible contribution of a glutathione conjugate to the long-duration action of beta-funaltrexamine.

The fumaramate derivative of naltrexone, beta-funaltrexamine (beta-FNA), is a highly selective long-lasting mu opioid receptor antagonist that is active both in vitro and in vivo, presumably as a result of covalent binding to a mu receptor-based sulfhydryl group. Glutathione, which occurs in significant levels in brain and liver, was found to undergo a Michael-type reaction with beta-FNA in the test tube to give a stable conjugate 3 which occurred as an isomeric mixture. When tested in the GPI and MVD smooth muscle preparations, 3 was found to possess one-tenth the agonist activity of beta-FNA is both tissues, but showed no irreversible antagonist activity. The same result was found for the cysteine conjugate 4, except for some irreversible antagonism in the MVD. Both conjugates antagonize the antinociceptive effect of morphine in the mouse radiant heat tail-flick assay on icv administration. This antagonism persisted and actually increased over 24 h and generally paralleled the duration profile of beta-FNA. On sc administration, beta-FNA and 3 showed similar duration of antagonistic effect, while 4 exhibited only marginal activity at the early time interval. When the compounds are compared by the dose to produce equivalent antagonism, beta-FNA and 3 appeared equally effective and accessible by either route, whereas 4 showed a large difference between the two routes. It is possible that the ultra-long antagonism of the conjugates may result from their enzymatic conversion to beta-FNA in the central nervous system in view of the fact that conjugate 5, which cannot be converted to beta-FNA, did not produce antagonism of long duration in vivo. Alternatively, the protracted antagonism could arise from sequestration of 3 and 4 in tissue compartments that interface with mu opioid receptors.

Analgesia↗
PubMed1993

Immediate reconstruction of complex cranioorbital fractures in children.

Six principles of craniofacial surgery were applied to the treatment of 7 consecutive pediatric patients who sustained complex cranioorbital fractures. These principles are (1) accurate assessment of the deformity, (2) early reconstruction, (3) complete exposure of the involved craniofacial skeleton, (4) accurate anatomical reduction of the fracture fragments, (5) use of rigid internal fixation, and (6) autogenous cranial bone grafting. Patient follow-up ranged from 6 to 52 months; evaluation included serial photographs, three-dimensional computed tomographic imaging, and cephalometric analysis. Application of these 6 craniofacial surgical principles provided definitive management in one operation, with optimal anatomical and functional reconstruction, and resulted in no detectable impairment to subsequent craniofacial growth.

Bone Transplantation↗
PubMed1993

Surgical anatomy of the SMAS: a reinvestigation.

There has been considerable disagreement in descriptions of the SMAS. Fresh cadaver dissection, combining anatomic dissection done with the aid of the operating microscope and histologic cross section of facial tissues, was performed in 24 facial halves. Histologic preparation was made on tissue macrosections, each 10 cm in length. Consistent findings include the following: (1) Although the SMAS is closely applied to the superficial surface of the parotid gland, a thin but distinct parotid fascia can be identified between parotid gland and SMAS. (2) The SMAS terminates superiorly within 1 cm below the zygomatic arch, and is not continuous with the temporoparietal fascia. (3) The SMAS in the cheek lies in continuity with the orbicularis oculi muscle of the lower eyelid. (4) Considerable variability exists in the histologic appearance of the SMAS in different facial regions within a single cadaver, as well as in a given facial region between cadavers. Because of its variability, histologic identification of the SMAS should be made in continuity with known reference structures, such as the platysma.

Adipose Tissue↗
PubMed1993

Long-term effects of radiation therapy in the head and neck.

The treatment and cure of cancer of the head and neck carry morbidity regardless of the disease process or modality employed. Although the effects of surgery are usually immediately obvious, those of radiotherapy evolve over time. This article reviews the long-term effects of radiotherapy for cancer of the oral cavity in adults and cancer of the mid and lower face in children and adolescents.

Adolescent↗