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Biomedical subjects

J C Lowry

Publications and source records attributed to J C Lowry.

At least 19 recordsLinked to original sources
PubMed1997

The role of second-intention healing in periocular reconstruction.

Second-intention healing is a time-honored method of wound management. Its role in periocular reconstruction, however, is currently controversial. The objectives of this thesis are threefold: to evaluate carefully the outcomes in a cohort of patients treated by this technique, to provide a comprehensive review of published reports, and to formulate recommendations and guidelines for appropriate application in selected patients. Eyelid and periorbital defects after excision of periocular tumors were allowed to heal by second intention in 59 patients. The locations of the wounds were the medial canthus (n = 32), lower eyelid (n = 20), upper eyelid, (n = 4), glabella (n = 2), and nasojugal fold (n = 1). Five excised areas involved the eyelid margin, and in three patients the defect included the canalicular system. The size of the defects ranged from 3 x 3 mm to 22 x 27 mm. The average duration of follow-up was 19 months (range, 6 months to 8 years). The functional and cosmetic results were satisfactory in 49 patients (83%). Complications occurred in 10 patients and included ectropion, medial canthal webbing, trichiasis, eyelid notching, and hypertrophic scarring. Only two patients, however, required secondary repair. Healing by second intention is a safe, effective, and inexpensive alternative to surgical reconstruction after tumor excision in selected patients.

Adult↗
PubMed1997

Who decides on the need for antibiotic prophylaxis in patients with major arthroplasties requiring dental treatment: is it a joint responsibility?

The role of antibiotic prophylaxis in patients with prosthetic joints who require dental treatment is controversial. A Working Party of the British Society for Antimicrobial Chemotherapy (BSAC) recently suggested that there was no evidence to support the use of antibiotic prophylaxis in these patients. The purpose of this study was to determine how closely these recommendations were being followed by maxillofacial surgeons (MFS), and to see if there was any consensus on the management of these patients between MFS and orthopaedic surgeons (OPS). With the aid of a postal questionnaire, the opinions of 250 consultant MFS and OPS were sought, response rates were 148 (59.2%) and 113 (41.2%), respectively. Of the OPS, 77.7% always recommended the use of antibiotic prophylaxis as opposed to only 29% of MFS. There were also wide differences in opinion with regard to the antibiotic that should be used in these patients, with the majority of OPS suggesting a cephalosporin, although this may not be the most efficacious antibiotic for oral streptococci. We conclude that this important matter seems to be far from satisfactorily resolved and that further cooperation between the specialties is required to produce guidelines for the safe and effective management of this increasing group of patients.

Antibiotic Prophylaxis↗
PubMed1996

Results of levator-advancement blepharoptosis repair using a standard protocol: effect of epinephrine-induced eyelid position change.

PURPOSE: Blepharoptosis repair by levator advancement is successful in most instances, but the postoperative eyelid level is not uniformly predictable. This study was undertaken to evaluate the possible effect of epinephrine (from local anesthetic) on eyelid position. METHODS: Seventeen adults with acquired unilateral ptosis as a result of levator aponeurosis dehiscence underwent levator aponeurosis advancement. The distance between the upper eyelid margin and the central corneal light reflex was measured preoperatively with the patient in both the upright and the supine position, 10 minutes after injection of 1.0 mL of anesthetic solution (2% lidocaine with 1:100,000 epinephrine and 12 U hyaluronidase per mL) in the supine position, intraoperatively after skin closure in the supine position, and 1 week or more postoperatively in the upright position. The ptotic lid was positioned intraoperatively in relation to the contralateral unoperated lid according to the change (presumably) induced by epinephrine stimulation of Müller's muscle. RESULTS: Eleven (65%) of the 17 patients had final postoperative lid positions within 1 mm between eyes. Two patients (12%) had undercorrection. Four patients (24%) had overcorrection by > 1 mm. The overcorrected lids were satisfactorily positioned, however, and none required further surgery; in 3 of these 4 patients, the unoperated lid had become ptotic, probably as a result of Hering's law. Differences between operated and unoperated lids and between the different times of measurement were analyzed. Significant changes in lid position occurred in the ptotic lids after injection (mean, +1.1 +/- 1.5 mm; median, +1.0 mm; P = .004) and in the final intraoperative difference between operated and unoperated lids (mean, +0.8 +/- 0.9 mm; median, +1.0 mm; P = .003). The change in the unoperated lid from preoperative upright to preoperative supine was significantly greater in the 6 failures (mean, -0.8 +/- 0.6 mm; median, -1.0 mm) than in the 11 successful outcomes (mean, +0.1 +/- 0.8 mm; median, 0.0 mm; P = .03). The change in unoperated lid position after injection of the ptotic lid was significantly greater in the failures (mean, +0.4 +/- 0.5 mm; median, +0.3 mm) than in the successful cases (mean, -0.2 +/- 0.4 mm; median, 0.0 mm; P = .02). CONCLUSION: Although it seems intuitively reasonable and clinically appropriate to account for the stimulatory effect of epinephrine during ptosis surgery, such intraoperative compensation alone did not yield a universally successful outcome in this study.

Adult↗
PubMed1995

Cilia incarnata.

Explore the source record for details and available documents.

Adult↗
PubMed1995

Thromboembolic disease and thromboprophylaxis in oral and maxillofacial surgery: experience and practice.

OBJECTIVE: (i) To determine the incidence of thromboembolic disease (TED) in major maxillofacial surgery and in particular deep vein thrombosis (DVT) and pulmonary embolism (PE). (ii) To determine current thromboprophylactic practice in the specialty. DESIGN: Retrospective survey by questionnaire of five year experience and current practice in UK maxillofacial surgical units. SUBJECTS: The patients of 130 consultants carrying out major maxillofacial surgery. MAIN OUTCOME MEASURES: (i) The number of cases of fatal and non-fatal PE and the number of diagnosed cases of DVT not progressing to PE. (ii) The frequency of use of mechanical and pharmacological thromboprophylactic measures. RESULTS: (i) There was a 79% return of questionnaires and from these were reported 60 cases of PE of which 14 were fatal with 64 cases of DVT not progressing to PE. Of the PE group almost 60% followed operations for orocervical malignancy while 25% were related to maxillofacial trauma. 64% of respondents had encountered no episodes of perioperative DVT and 68% no cases of PE. (ii) Mechanical thromboprophylactic measures included the use by 76% of respondents of a graduated compression garment, ripple mattress by 47% and intermittent inter-operative calf pressure by 38.5%. Of pharmacological agents 45% used low dose heparin, 14.5% a dextran infusion and 6% an antiplatelet agent. 58.3% gave advice about smoking and 37.5% recommended temporary discontinuation of the contraceptive pill. CONCLUSIONS: The incidence of DVT and PE in major maxillofacial surgery is low. Nevertheless it is recommended that there is rigid compliance with the recommendations for surgery in general from the thromboembolic risk factors consensus group (THRIFT) and from similar groups in Europe and the USA.

Anticoagulants↗
PubMed1995

Electromyographic studies of the reconstructed lower eyelid after a modified Hughes procedure.

PURPOSE: We evaluated quantitatively, with electromyography, the function of orbicularis oculi muscle flaps in modified Hughes reconstructions of the lower eyelids. METHODS: A modified Hughes procedure with a bipedicle orbicularis oculi flap was used to reconstruct large left lower eyelid defects after tumor excision in six consecutive patients. Standard needle electromyography and facial nerve conduction studies were performed on each reconstructed lower eyelid, and results were compared with those of the unoperated-on right lower eyelid. Electromyographic studies were performed between 143 and 517 days after division of the tarsoconjunctival flap. RESULTS: Blink reflexes and results of facial nerve studies were normal and similar on both sides. All operated-on eyelids demonstrated electromyographic activity during voluntary orbicularis contraction. The functional and cosmetic results were satisfactory in all patients. No complications of reconstruction, such as eyelid retraction, ectropion, tissue necrosis, or abnormal contour or thickness, occurred. CONCLUSIONS: A modified Hughes procedure using a bipedicle orbicularis oculi flap provides viable, electrically active muscle to the reconstructed lower eyelid and may enhance the functional results.

Blinking↗
PubMed1994

The percutaneous dilatational subcricoid tracheostomy.

Tracheostomy is frequently required during maxillofacial procedures. The percutaneous technique is described and advocated as a rapid easily mastered procedure, although there is a definite learning curve and it is not without a potential for complications.

Humans↗
PubMed1993

Intraoral inflammatory pseudotumor.

A case of an intraoral inflammatory pseudotumor is described. Although this lesion has been reported to occur in the oral cavity, no cases have been documented in the literature. Difficulties were encountered in arriving at a diagnosis in a patient with a condition in the mandible.

Adult↗
PubMed1992

Argon laser treatment of trichiasis.

The argon laser was used to treat trichiasis in 44 patients over a five-year period. During follow-up intervals of between one month and more than four years (mean, 13 months), ablation of misdirected cilia was accomplished with one treatment in 26 patients (59%). No complications were observed. Laser is less effective than cryotherapy for destroying aberrant eyelashes, but cryotherapy is less precise and incites greater posttreatment inflammation. Argon laser treatment is a useful option when only a few, scattered eyelashes require ablation or in patients with disorders such as ocular pemphigoid, in which the stimulation of inflammation is undesirable.

Adult↗
PubMed1991

Identifying progression of subclinical keratoconus by serial topography analysis.

We performed serial slit-lamp examinations and topography analysis on a patient whose initial topographic map suggested a diagnosis of keratoconus to us but which others interpreted as normal topography. Topography analysis documented cone progression during a two-year period. The initial map showed a cone apex power of 44.5 diopters located 2.1 mm inferior to the vertex normal. An oblong-shaped area of maximum power was surrounded by concentric bands of lower power. Corneal surface power ranged from 41.5 to 44.5 diopters. Two years later cone apex power increased to 51.0 diopters, and the patient developed a Fleischer's ring, Vogt's striae, and mild visual aberration. Our findings suggest the use of topography analysis systems in documenting subclinical cone progression. Topography systems may be a useful tool in the study of the true incidence and natural progression of subclinical keratoconus.

Cornea↗
PubMed1990

Maxillofacial surgery: the economic aspect.

Fifteen years ago when the expenditure on the National Health Service was 2600 million pounds annually, an economic survey of the then more common procedures carried out by oral and maxillofacial surgeons in the UK was undertaken. After three reorganisations of the NHS with a fourth pending the overall cost has escalated to 21.6 billion pounds. The specialty has also seen significant change with a broader spectrum of work being carried out and a greater proportion of major cases being undertaken. The paper shows how previously costed procedures have changed; for example with increasing use of day care facilities and internal fixation techniques, before moving on to consider costings for the more advanced operations now being carried out on a regular basis. In an era of resource management with progressive stringency of funding in the acute sector it has been suggested that some procedures are uneconomical and others possibly should not take high priority. Under these circumstances it has become especially important to justify all facets of practice of the specialty and this aspect is considered in terms of the cost to the National Health Service, the quality of life of the patient and the cost to the economy as a whole in Social Security benefits and loss of productivity.

Costs and Cost Analysis↗
PubMed1990

Matched group study of preenucleation radiotherapy versus enucleation alone for primary malignant melanoma of the choroid and ciliary body.

We report the results of a nonrandomized, matched group survival study comparing 29 patients with a choroidal or ciliary body melanoma managed by enucleation alone to 29 patients managed by enucleation following external beam ocular irradiation (20 Gy in five fractions over 5-7 days just prior to enucleation). Variables on which the patients in the two groups were matched included age at time of enucleation, largest linear tumor dimension, location of the anterior tumor margin relative to the equator and ora serrata, melanoma cell type, and extrascleral tumor extension. The cumulative 5-year survival in the enucleation alone group was 57.9% (SE = 9.9%), whereas that in the preenucleation radiation therapy group was 63.9% (SE = 12.2%). This difference is not statistically significant (p greater than 0.5, Mantel-Haenszel test). The authors discuss the strengths and limitations of their study and the implications of their results.

Adult↗