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Biomedical subjects

H Seikaly

Publications and source records attributed to H Seikaly.

13 recordsLinked to original sources
PubMed1998

Teaching paradigm for decision making in facial skin defect reconstructions.

OBJECTIVE: To present a decision paradigm for facial defect reconstruction, and test the ability of this paradigm to improve resident performance. DESIGN: A decision paradigm for reconstruction of facial skin defects is proposed and explained, with patient examples. The paradigm's usefulness is then tested with residents. SETTING: Otolaryngology residency training program at a tertiary hospital. STUDY PARTICIPANTS: Otolaryngology residents. INTERVENTIONS: Twelve residents took a pretest wherein they were presented with drawings of skin defects and asked to choose the "best" (most aesthetically pleasing) type of reconstruction from a closed set. This paradigm was presented to these residents, and their posttest consisted of choosing again with the same defects and closed set of choices. MAIN OUTCOME MEASURES: Cosmetic outcomes of reconstructive decisions on the pretest and posttest were rated on a scale of 0 to 5 (with 0 indicating poor; 5, excellent). RESULTS: There was a significant improvement in reconstructive choices between the pretest and posttest (P<.001, Student t test). CONCLUSION: This paradigm can be easily modified to accommodate different surgical approaches preferred by individual surgeons and is thus useful in almost any reconstructive teaching situation.

Algorithms↗
PubMed1998

Combined Epstein-Barr virus and human papillomavirus infection in nasopharyngeal carcinoma.

Epstein-Barr virus (EBV) has been shown to be a likely etiologic agent in nasopharyngeal carcinogenesis. Human papillomaviruses (HPVs) have previously been identified in numerous upper aerodigestive tract carcinomas. This pilot study was undertaken to investigate the prevalence of combined EBV and HPV infection in 17 patients with nasopharyngeal carcinoma (NPCA) using polymerase chain reaction (PCR). The primary goal was to determine if the presence of HPV could be correlated with molecular, histologic, or clinical parameters. There were seven patients with undifferentiated NPCA (World Health Organization [WHO] type III) and 10 patients with squamous cell carcinoma (WHO type I). All 17 patients had stage IV disease at presentation. EBV was identified in 15 patients (88.2%), and HPV subtypes were identified in samples from nine patients (52.9%). All HPV-positive cases were also EBV positive. Western blot analysis of six samples showed a high level of expression of c-myc and cdc2 kinase and a low level of p53 protein in NPCAs that contained both HPV and EBV (n = 3). Increased expression of c-myc and cdc2 kinase was seen in the cases that contained EBV only, but to a lesser extent (n = 2). These findings indicate an effect of the virus on cellular proliferation and differentiation. Similarly, an elevated level of Rb protein was found only in the HPV-containing NPCAs. Moderate differentiation (keratinization) occurred in four of eight HPV-negative and none of the nine HPV-positive NPCAs. (All HPV-positive cases were poorly differentiated or undifferentiated.) This difference is statistically significant for this sample size (P < 0.03). There was a trend for the group that was HPV positive to have WHO III histology and for the HPV-negative group to have WHO I. The presence of HPV could not be correlated with any clinical parameters in this small group of patients with advanced disease; however, these data suggest that coexistence of EBV and HPV infection may be a factor in the pathogenesis of NPCA and may have an effect on regulation of cellular proliferation and differentiation.

Adolescent↗
PubMed1997

Communication after laryngectomy. An assessment of patient satisfaction.

OBJECTIVES: To determine the satisfaction of patients with their current method of alaryngeal communication. To focus primarily on the patients' perception of their own speech. DESIGN: A retrospective review of patients who underwent total laryngectomy for malignancy identified 4 groups of patients. A survey using a mailed questionnaire was used to compare groups. SETTING: Tertiary care university hospital, University of Texas Medical Branch at Galveston. PATIENTS: Forty-seven patients underwent total laryngectomy for cancer and survived. Thirty-one of the 47 patients responded to the survey. Patients were divided into 4 groups by their current method of communication: (1) tablet writers; (2) esophageal speech; (3) electrolarynx; and (4) tracheoesophageal speech. MAIN OUTCOME MEASURES: Satisfaction with communication, satisfaction with speech quality, ability to communicate over telephone, limitation of interaction with others, and satisfaction with quality of life. RESULTS: Patients in group 4 were significantly more satisfied with their speech (P < .001), perceived their speech to be of better quality (P < .001), had improved ability to communicate over the telephone (P < .001), and had less limitation of their interactions with others (P < .004). Patients in group 4 also rated their overall quality of life higher (P = .23). CONCLUSION: Although many studies in the past have demonstrated the objective superiority of tracheoesophageal speech compared with other methods of alaryngeal communication, most studies have focused on the intelligibility of speech judged by listeners. This study demonstrates that patients who use tracheoesophageal speech rate their own speech significantly higher than patients who use other methods and most likely have an overall superior quality of life.

Adult↗
PubMed1997

The clavipectoral osteomyocutaneous free flap.

Microvascular free tissue transfer has revolutionized head and neck reconstruction and currently is considered the most successful and reliable method of primary oromandibular reconstruction. This study was designed to assess the feasibility of full thickness free vascularized transfer of the clavicle based on the clavicular branch of the thoracoacromial artery and the soft tissue component associated with the thoracoacromial axis. Forty dissections of the pectoral region were performed on 26 cadavers. The anatomic relations of the region and the thoracoacromial arterial and venous systems were documented in detail. Selective ink injections of the thoracoacromial arterial branches were also performed on fresh cadavers. The clavicle was supplied mainly by the clavicular artery (medial three quarters), with minor contribution from the deltoid artery (lateral quarter). An average of 16.1 cm (range of 12 to 20 cm) was obtained with total clavicular harvest and the clavicle had sufficient width and height to support dental implants. Two soft tissue donor sites were associated with the thoracoacromial artery: the sternocostal head of the pectoralis major muscle, with the overlying skin supplied by the pectoral artery, and the clavicular head of the pectoralis major muscle, with the overlying skin supplied by the deltoid and clavicular arteries. Sensory innervation of the upper chest was supplied through the supraclavicular nerves, whereas the lateral pectoral nerve supplied motor innervation to both heads of the pectoralis major muscle. The anatomy of the clavipectoral donor site and the first case of full thickness free clavicular transfer for mandibular reconstruction in the English literature are presented. The donor site is an excellent source of well vascularized, thin, pliable, hairless, potentially innervated (motor and sensory) soft tissue, along with up to 20 cm of clavicular bone. The surgical anatomy is familiar to the head and neck surgeon. The harvesting does not require repositioning of the patient and is amenable to a two-team, simultaneous approach. The functional and cosmetic donor site morbidity is minimal even with clavicular harvest. The major disadvantage of this flap is the relatively short pedicle. The authors conclude that the thoracoacromial system provides a free flap with osseous and soft tissue components that are well suited for oromandibular reconstruction.

Acromion↗
PubMed1997

Extended use of topical nasal decongestants.

Use of sympathomimetic topical nasal decongestants to treat nasal obstruction is usually restricted to 3 to 5 days to avoid potential rebound swelling (rhinitis medicamentosa). In this study, 10 healthy volunteers used oxymetazoline (long-acting topical nasal decongestant) nightly for 4 weeks. Subjects who used antihistamines, oral or topical decongestants, or systemic steroids or who had active sinusitis were excluded from the study. Weekly history, physical examination, and anterior rhinomanometry revealed no adverse effects. Eight (80%) subjects developed nightly nasal obstruction a few hours before the evening dose; the obstruction resolved within 48 hours if no more decongestant was used. All subjects remained responsive to oxymetazoline 4 weeks and 8 weeks after the study began. This finding suggests that long-acting decongestants may be safely used for longer than the recommended 3 to 5 days without adverse effects if used once nightly.

Humans↗
PubMed1996

Biomechanics of the helical rim advancement flap.

OBJECTIVES: To determine how helical rim closure with advancement flaps affects ear length and cupping, to compare the tension of closure with wedge excision and helical rim advancement and the effects of 3 tension-decreasing surgical techniques, and to review clinical experience with this flap. DESIGN: The laboratory study was performed on 6 fresh cadaver ears, by means of sequential excision of tissue, and closure tension was measured with a strain gauge. Results obtained in 10 patients were reviewed. SETTING: University referral hospital. PATIENTS: Ten patients with helical rim defects treated with helical rim advancement flaps. INTERVENTION: In cadaver ears, a helical rim defect of 5 mm was enlarged sequentially to 10 mm, 15 mm, and finally 20 mm. In the patients, defects of the helical rim caused by trauma or tumor were closed by this helical rim advancement flap method. MAIN OUTCOME MEASURES: For the laboratory study, the outcome measures were tension of closure of the defect, ear length, and ear cupping. For the review of cases, outcome was determination of perioperative complications and the patient's and surgeon's judgment of cosmetic appearance. RESULTS: Closure of a helical rim defect with advancement flaps caused minor shortening and moderate cupping of the ear. The tension of closure was decreased by extending the inferior incision into the earlobe, creating a Burow triangle, and shaving cartilage from the scapha. Both the Burow triangle and the scaphal shave caused mild increases in ear cupping. CONCLUSION: Helical rim advancement flaps provide satisfactory closure of helical rim defects up to at least 20 mm (longer in some ears) with excellent preservation of normal anatomic landmarks and a near-normal appearance of the reconstructed ear.

Adolescent↗
PubMed1995

Gastroesophageal reflux prophylaxis decreases the incidence of pharyngocutaneous fistula after total laryngectomy.

Pharyngocutaneous fistula is a serious complication after laryngectomy. Gastric fluid is known to cause severe laryngopharyngeal injury and poor mucosal healing. This study was designed to evaluate the effects of a gastroesophageal reflux prophylaxis regimen on the incidence of fistula after laryngectomy. Twenty-one consecutive patients were entered in the study. Patients with positive resection margins were excluded from the overall analysis. All patients had a Connell's two-layer closure of the pharynx with absorbable suture, suction drainage of the neck, postoperative tube feeding, and prophylactic antibiotics. All patients were started on an antireflux regimen postoperatively composed of continuous tube feeds, intravenous ranitidine, and intravenous metoclopramide hydrochloride. Patients were followed postoperatively with Gastrografin swallows and clinically for 8 weeks. The control group consisted of retrospectively studied patients managed identically except for the antireflux prophylaxis. The two groups were well matched for factors reported to influence the rate of pharyngocutaneous fistula formation. The control group had six fistulae (26%) and an average of 16.5 days of hospital stay. The study group had no fistulae and an average of 11.5 days of hospital stay (P = .02). This study suggests that gastroesophageal reflux may predispose to fistula formation after laryngectomy and that mechanical and pharmacological prophylaxsis decreases postoperative morbidity and length of hospital stay.

Adult↗
PubMed1994

Infantile subglottic hemangioma.

Infantile subglottic hemangiomas are rare congenital lesions of the larynx that are difficult to manage. Our experience with 10 cases was reviewed. All patients presented with stridor at birth, or shortly after. The minimum follow-up was 6 months, with an average of 44 months. The patients were classified and treated according to the size of the hemangioma. The treatment included expectant management, systemic steroids, CO2 laser excision, and tracheostomies. Overall, eight patients were cured, one developed subglottic stenosis, and one died due to unrelated causes. We recommend that (1) patients with small lesions (< 25% of lumen) be treated expectantly, (2) patients with moderate lesions (25-60% of lumen) be treated with systemic steroids initially, and CO2 laser excision if steroids fail, and (3) patients with large lesions (> 60% of lumen) be treated with tracheostomies initially, and staged CO2 laser excision.

Combined Modality Therapy↗
PubMed1990

Pulmonary atelectasis after reconstruction with pectoralis major flaps.

Forty-four patients were reviewed to determine the incidence of atelectasis following pectoralis major myocutaneous flap reconstruction of head and neck defects. Patients underwent tumor resection with subsequent pectoralis major myocutaneous flap reconstruction (flap group, n = 24) or another major head and neck procedure (control group, n = 20). Chest roentgenograms taken on the first postoperative day were scored for atelectasis by preestablished criteria. Sixty-five percent of control and 70% of flap patients demonstrated postoperative atelectasis roentgenographically. The flap patients with skin paddles larger than 40 cm2 had a 60% incidence of major atelectasis compared with 5% in control patients. The skin island area was strongly correlated with the atelectasis score in the flap group. These results suggest that atelectasis is common following pectoralis major myocutaneous flap reconstruction of head and neck defects. As well, decreased chest wall compliance after primary closure of large donor defects may contribute to the atelectasis observed.

Carcinoma, Squamous Cell↗