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Biomedical subjects

H A Zarem

Publications and source records attributed to H A Zarem.

At least 19 recordsLinked to original sources
PubMed1997

Browpexy: lateral orbicularis muscle fixation as an adjunct to upper blepharoplasty.

Lateral ptosis of the eyebrow is a major part of the complex changes that patients are seeking to improve with an upper blepharoplasty. Two hundred and eight patients have undergone a browpexy procedure at the time of blepharoplasty. This operative maneuver, which is performed through the blepharoplasty incision, prevents the brow from dropping below the superior orbital rim and creates a defined tarsal sulcus to produce a sculptured upper eyelid.

Adult↗
PubMed1995

Localized Mycobacterium avium-intracellulare mastitis in an immunocompetent woman with silicone breast implants.

While M. avium-intracellulare has received increasing recognition due to its association with AIDS, silicone breast implants have come under increased FDA scrutiny, requiring new safety and efficacy protocols. We report a case of localized M. avium-intracellulare mastitis associated with a breast implant in an immunocompetent, HIV-negative woman who was cured with implant removal and a long course (6 months) of clarithromycin. Serous exudates occurring in association with breast implants should be cultured for acid-fast organisms. Clarithromycin may be a therapeutic adjunct to effectively cure these infections.

Adult↗
PubMed1993

Minimizing deformity in lower blepharoplasty. The transconjunctival approach.

The transconjunctival approach offers many advantages for lower blepharoplasty. It addresses bulging fat directly, minimizes late lid retraction problems, permits skin resection if indicated, and retains the natural appearance of the palpebral fissure. The technique is straightforward and is easily mastered once the relevant anatomy is understood.

Adult↗
PubMed1992

Operative technique for transconjunctival lower blepharoplasty.

In the past 3 years, more than 125 patients have undergone primary and secondary lower blepharoplasty by the transconjunctival method. The ability to adequately remove fat with this approach has been impressive. Exposure of the central and medial fat compartments is excellent. The lateral fat pad area is not as easy to visualize, and care must be taken to assure that adequate fat removal is achieved. Although one might suspect that postoperative conjunctival irritation could be a problem with this procedure, this has been notably absent in our patient population. In addition, there have been remarkably few patients with dry eye complaints following transconjunctival lower blepharoplasty. The question of skin resection must also be addressed. Currently, we believe that the majority of patients seeking improvement of the lower eyelids benefit most by a transconjunctival blepharoplasty without skin resection (Figs. 3 and 4). When there is obvious skin excess, we believe that it is best approached by removing the fat through the transconjunctival incision and then removing skin with a simple skin flap or skin pinch technique. This must be done considerably more conservatively than has been recommended in the past, to retain a natural palpebral fissure. Secondary skin removal, if necessary, is a straightforward procedure that can be readily done under local anesthesia at a later date. Transconjunctival lower blepharoplasty has not been associated with prolonged (exceeding 1 month) lower lid retraction problems in any of our patients. The technique is easy to learn but does require some experience with the anatomy. The technique should become the basic procedure for correction of excess fat in the lower eyelids.

Aged↗
PubMed1991

Expanded applications for transconjunctival lower lid blepharoplasty.

There has been a recent upsurge in interest in the transconjunctival approach for lower lid blepharoplasty. Initial reports have focused on the young patient with isolated fat prominence. We describe our experience with transconjunctival lower lid blepharoplasty in 104 patients over the past 2 years. There have been no instances of prolonged lower lid retraction problems, presumably related to leaving the skin, orbicularis, and orbital septum intact. Our experience with expanding the indications for the transconjunctival approach to include patients with fine skin wrinkling as well as frank skin excess has been extremely favorable. We conclude that the skin excess is often more apparent than real, with the skin being necessary to recontour the lower eyelid after fat excision. Although skin excision may be required during the initial procedure or at a later stage, patients with apparent skin excess need not be excluded from consideration for transconjunctival lower lid blepharoplasty.

Adipose Tissue↗
PubMed1988

Effect of corticosteroid administration in ischemia--ischemic injury.

In order to study the preservation of ischemic tissue, an in vivo end-artery model was designed using the rabbit ear. Ear surface-area necrosis and ear edema were quantitatively evaluated for 14 postoperative days in a total of 107 rabbits. The LD50 of ischemic injury was determined by effecting 8, 10, and 12 hours of circulatory arrest. Using a 12-hour ischemic interval in this model, methylprednisolone decreased edema formation (p less than 0.01) and dramatically halted the progression of ischemic injury to necrosis (p less than 0.05) when administered within 5 hours after the onset of ischemia and continued for 3 postoperative days. A single perioperative dose of methylprednisolone was ineffective in decreasing edema formation and preserving tissue. Administration of steroids greater than 5 hours after the onset of ischemia was similarly ineffective even when administered for 3 postoperative days.

Animals↗
PubMed1987

Surgical correction of late sequelae from facial bone fractures.

This study has described the UCLA experience over a 5 year period in the treatment of secondary traumatic deformities utilizing the craniofacial techniques originally proposed by Tessier. Because of scarring, absent parts, and the malposition of segments, correction of long-standing traumatic deformities remains difficult and treatment results remain less than ideal. Primary correction utilizing the principles we have described herein still provides the best functional and aesthetic results. Facial fractures can no longer be considered as an independent and unrelated entity when dealing with the traumatized patient. If primary reconstruction continues to be compromised, correction of residual disfigurement will result in unnecessary patient morbidity and disturbances of facial form and function.

Accidents, Traffic↗
PubMed1987

Tumors of the epidermal appendages.

Benign tumors of the epidermal appendages frequently frustrate patient and doctor because of the uncertainty of the nature of the lesion and the choice that the benign lesion presents. Recognition and definitive management is usually straightforward with appropriate attention to the history and to the lesion. Knowledge of these benign epidermal appendage lesions can minimize time loss and expense and help to avoid unnecessary scars.

Adenoma↗
PubMed1983

Salvage of the exposed irradiated mandible.

Maintaining the continuity of the tumor-free mandible is a priority objective in managing the patient with head and neck cancer. After review of seven patients with cutaneous or intraoral bone exposure from osteoradionecrosis of the mandible, we recommend treatment consisting of debridement of soft necrotic bone, retention of dry sclerotic bone, and coverage with well-vascularized flap tissue. Utilizing this therapeutic plan, we have preserved mandibular architecture and obtained primary healing of the wounds.

Aged↗
PubMed1982

Surgical management and reconstruction of extensive chest wall malignancies.

Seven patients aged 8 to 77 years underwent massive resection for chest wall malignancies. Two had chondrosarcoma, one recurrent breast cancer, one malignant hemangioepithelioma, one embryonal cell sarcoma, one metastatic osteogenic sarcoma, and one lymphangiosarcoma. The smallest surgical defect was 17 by 19 cm, the largest 35 by 45 cm. Closure was done with Marlex mesh, full-thickness muscle flaps, or free island pectoralis or latissimus dorsi flaps. The rotation of myocutaneous island flaps (bilateral in two patients) greatly facilitated reconstruction. No infection, pulmonary compromise, or operative morbidity or mortality was encountered. The age of the patients and the location or size of the lesions were not significant factors. Designing a surgical strategy which provides adequate full-thickness margins and immediate reconstruction is critically important. Massive chest wall resection for malignancy should be pursued aggressively whenever these lesions are encountered. The operations can be performed safely and can be curative, and the benefits to patients in terms of comfort and prolonged survival justify this extensive surgery.

Adolescent↗
PubMed1982

Tissue reaction to ischemia in the rabbit ear chamber: effects of prednisolone on inflammation and microvascular flow.

The rabbit ear containing a mature Lucite chamber was subjected to ischemia in 25 rabbits. The ischemic insult lasted in one group for 2 hours, in the second group for 5 hours, and in a third group for 5 hours with the addition of systemic prednisolone therapy. The gross edema of the ear, restoration of flow within the microvasculature in the rabbit ear chamber, and the occurrence and resolution of the cellular inflammatory response were documented by daily in vivo observations of the chamber. The 2-hour ischemic period resulted in a relatively insignificant injury, but the 5-hour ischemic period resulted in edema of the ear, changes in the flow within the microvasculature, and a cellular inflammatory response that increased in intensity for the first 24 hours following ischemia. Ultimate resolution of these changes was noted in all the animals. Systemic administration of prednisolone dramatically reduced the occurrence of edema and reduced the intensity of the inflammatory response, which resolved in a shorter period of time than in untreated animals. These studies demonstrate that ischemia evokes a classic inflammatory response that is inhibited by the administration of systemic steroids.

Animals↗
PubMed1980

Recurrent basal cell carcinoma. A review concerning the incidence, behavior, and management of recurrent basal cell carcinoma, with emphasis on the incompletely excised lesion.

Although controversial among dermatologists and surgeons, the conclusion based on this review is that basal cell carcinomas, with marginal histologic involvement, should be reexcised. When the margins contain tumor with one high-power field (400X), it is reasonable, in view of the 12 percent recurrence risk, to carefully follow patients who are elderly or are experiencing other extenuating circumstances.

Age Factors↗
PubMed1979

Surgical management of silicone mastitis.

The results of the operative treatment of 22 cases of silicone mastitis are presented. Moderate involvement can usually be managed successfully by local excision of the masses, or by a subcutaneous mastectomy with later reconstruction. Patients with severe skin infiltration and/or pectoral muscle involvement are prone to complications, however, and we now believe an aggressive approach--such as a complete mastectomy with nipple banking and excision of the infiltrated muscle, might be best. This would allow the later reconstruction to proceed in relatively uninvolved tissue, and prevent the problems of recurrent inflammation from placing bag-gel prostheses in a residual bed of silicone-infiltrated tissue.

Adult↗