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Biomedical subjects

J Conley

Publications and source records attributed to J Conley.

At least 55 records · Page 3Linked to original sources
PubMed1983

Dual simultaneous systems for facial reanimation.

Successful reanimation of the paralyzed face requires a specific yet adaptable procedural armamentarium. Usually, in the treatment of regional paralysis, one distinct technique is deemed most appropriate and dependable. In cases of total hemiparesis secondary to surgical ablation or trauma, however, the simultaneous use of two separate but complementary rehabilitative systems has proved valuable in 15 patients. The reconstructive concept described divides the face into two functional spheres, an upper periorbital area and a lower perioral region. The integral system includes a direct facial nerve-to-cable graft reanastomosis for the upper division combined with a masseter muscle transfer for the lower facial region. The immediate supportive effects of the masseter transposition integrated with its long-term ability to rehabilitate via myoneurotization complement the more physiologically exacting effects of the nerve anastomosis.

Adult↗
PubMed1983

Vocational adaptation of patients on home dialysis: its relationship to personality, activities and support received.

This analysis identifies, in terms of relative contribution, seven independent variables which appear to be associated with the vocational adaptation of home dialysis patients. The tentative model created by the analysis can be used as a guide for assessing a patient's potential vocational adaptation. It has also identified some conditions associated with adaptation which are amenable to treatment by dialysis staff. Validation of the model, however, requires further testing with other patient groups.

Activities of Daily Living↗
PubMed1983

Mini alar myocutaneous flaps for nasolabial-columella reconstruction.

A new midfacial myocutaneous flap that is particularly useful in nasolabial-columella reconstruction is described. The mini alar flap is a randomized myocutaneous island flap incorporating portions of the orbicularis oris, levator labi superioris alae (labial portion), levator labi superioris, and zygomaticus minor, based on a vascular supply from the terminal branches of the facial artery. The flaps allow for a bilateral elipse of skin and underlying muscle to be transferred from the lateral nasal area into the midportion of the columella and the upper lip for reconstruction of ablative, traumatic, or congenital defects. The primary advantage of the mini alar flap lies in the ability to transpose moderate quantities of viable, well-matched tissue with minimal donor area deformity.

Female↗
PubMed1983

Carcinoma of the maxillary sinus. A correlation of the clinical course with orbital involvement, pterygoid erosion or pterygopalatine invasion and cervical metastases.

A retrospective review of 112 cases treated by one author (J.C.) over the 21 year period 1953-1973 is performed. In 62% of the cases squamous cell carcinoma was the histologic diagnosis, with adenoid cystic carcinoma accounting for a further 16%. The remaining histologic types were few in number and included fibrosarcoma, muco-epidermoid carcinoma, melanoma, chondrosarcoma, adenocarcinoma, malignant Schwannoma, lymphosarcoma, malignant mixed tumor, rhabdomyosarcoma, angiosarcoma, and osteogenic sarcoma. Three years following diagnosis more than 1/3 of the squamous cell carcinomas were alive but by 10 years the survival rate had fallen to 16%. Orbital involvement at the time of presentation or noted at surgery had a poor prognosis with a 17% five year cure rate and only 2% alive at 10 years. Erosion of the pterygoids or pterygopalatine fossa invasion as diagnosed radiologically or intra-operatively revealed all patients dead of disease within five years despite radical surgery and irradiation. Cervical nodal metastases at primary presentation was a particularly ominous finding with all patients dead of disease within three years. Metastases developing later had a better prognosis with 39% surviving five years when treated aggressively.

Adolescent↗
PubMed1982

Adenoid cystic carcinoma involving the external auditory canal. A clinicopathologic study of 16 cases.

Sixteen patients with a rare tumor, adenoid cystic carcinoma (ACC) involving the external auditory canal, have been studied. Clinically, most patients complained of ear pain, often of several years duration. On physical examination, a mass or a nodule usually was identified in the ear canal. In most cases, treatment consisted of a wide surgical resection of the auditory canal and adjacent structures. Histologically, these neoplasms had the same appearance as ACC originating in salivary glands. In eight cases, the tumor was confined to the ear canal wall and unquestionably arose in this area, probably within the ceruminous glands. When incompletely excised, these lesions usually recurred locally. Nine patients had a total of 26 local recurrences. Most recurrences were found within two years of the preceding treatment, but the interval in some cases was long, ranging up to 14 years. Of the 16 patients, seven had no evidence of recurrence following surgical resection, two were living with recurrent, unresectable tumor, five had died of disease, one had died of other causes, and one was lost to follow-up. Some patients died of tumor after a prolonged clinical course with multiple recurrences. Death usually was caused by intracranial extension by the tumor, or by pulmonary metastases. Radiotherapy did not appear to cure the lesion, but probably resulted in palliation. An increased incidence of recurrent, unresectable tumor or of death from the neoplasm correlated with the following histologic features: demonstration of tumor on the lines of surgical excision, involvement of the parotid gland, extension into bone, perineural invasion and local recurrence of tumor.

Adult↗
PubMed1982

Intraoral masseter muscle transposition: use with reconstruction of regional facial paralysis.

The treatment of regional facial paralysis of the lips and commissure by masseter muscle transposition is well accepted and usually accomplished by an external approach. The intraoral transfer demonstrates distinct advantages for the rehabilitation of midfacial regional paresis. The procedure is performed totally intraorally, which exposes the masseter muscle before transposing the anterior portion in a subcutaneous tunnel to the upper and lower lips. The effects of this transposition are direct support and immediate contraction, with eventual myoneurotization of the surrounding perioral musculature. The indications, operative considerations, and results in 22 cases are reported. This technique considerably advances the procedural approaches of the reconstructive surgeon and in used either in conjunction with other reconstructive modalities or as a primary procedure in selected cases.

Facial Paralysis↗
PubMed1982

Paralysis of the mandibular branch of the facial nerve.

A direct and simple operation of transfer of the anterior belly of the digastric muscle with its attached tendon is presented. It was carried out in 36 patients, with three minor complications. It has proved effective in paralysis of the mandibular division of the facial nerve as a primary or secondary procedure. In ablative resections where this branch of the nerve is intentionally sacrificed, it is advised to do the muscle and tendon transfer as part of the primary operation. In aesthetic operations or where the status of the nerve (post-operatively) is not specifically know, it is advised to wait for spontaneous return for an interval of 3 to 6 months. If the improvement is not satisfactory, then this technique may be considered.

Facial Muscles↗
PubMed1982

Psychological and physiological factors predicting the outcome on home hemodialysis.

As part of a study of "Adaptation to home dialysis" we have examined psychological, physiological, and social factors influencing the success of 136 patients on home hemodialysis, followed for greater than 18 months. The study has demonstrated specific physical, psychological, and stress factors associated with increased probability of failure on home hemodialysis. In those under 45 years of age, the profile of failure is of higher diastolic blood pressure in training, more frequent episodes of congestive heart failure, higher levels of stress associated with varying health and loss of sleep and greater anxiety and depression. In the older age group failure was associated with higher levels of depression and self depreciation, and higher levels of stress associated with fear of death, pain during dialysis and blood clotting. On the other hand, higher denial levels were positively correlated with success. There were no significant differences between profiles of those patients who succeeded and those who died. Although analysis is based on a retrospective study, the time sequence between data collection and end points suggests that patient profiling can be used in a predictive manner. The study emphasizes the importance of psychological and social factor analysis in the overall management of the patient with renal failure.

Adult↗
PubMed1981

Ethics in head and neck surgery.

Ethical problems have been a part of medicine since it became a cult, an art, and then a science. Ethics in surgery of the head and neck have developed a special poignancy because of the astounding advances in medical science and technology with their application to this exposed area of the body that is so intimately related to esthetics and physiologic function. When the patient and his family are confronted with a potentially life-threatening disease that requires surgical management, the basic human and civil rights of the patient and his physician come into acute focus. It is within this framework of rights and responsibilities that the patient's welfare must be managed. This ongoing evolution in our mores must grapple with problems that Hippocrates never dreamed of; yet, this is precisely the area of activity that provides the best in medical service with the highest dignity to the profession.

Disclosure↗
PubMed1981

A composite hair-bearing and non-hair-bearing sideburn flap.

A versatile and dependable composite hair-bering and non-hair-bearing flap is described that allows for immediate reconstruction in the highly visible temple and preauricular areas. A combined hair-bearing and non-hair-bearing flap is transferred from the postauricular region to the area of the temple and laterally to the orbit. Modification of the flap by harvesting additional tissue from the posterior conchal region assures greater reconstructive potential and variability.

Face↗
PubMed1981

Measurement of hypothetical burnout in cystic fibrosis caregivers.

Three hypothetical phases of staff burnout were measured in a population of cystic fibrosis caregivers and a control population from other areas of specialty pediatrics. The cystic fibrosis caregivers displayed a higher level of emotional exhaustion, lower level of patient depersonalization, and an equal sense of personal accomplishment from the job compared to the controls. We conclude that hypothetical staff burnout can be measured and postulate that these values can be used to quantitate the outcome of anti-burnout programs.

Adult↗
PubMed1981

Occult neoplasms in facial paralysis.

A review of 14 cases of occult neoplasms associated with facial paralysis indicated that when the onset was gradual over a period of weeks or months, when all of the scientific and technological investigations, including CT scanning, polytomes, neurosensory and otologic tests, sialography, lacrimation, taste, internal acoustic meatus, evaluation of the deep lobe of the parotid, and clinical examination of the parotid and neck were negative, the tumor was almost always found in association with the main trunk of the extratemporal portion of the parotid gland. Of these neoplasms, 80% were malignant tumors of the parotid gland and 15% were neurilemmomas of the main trunk of the facial nerve. The above situation is an indication for human assessment by surgical investigation of the facial nerve, with the first priority being given to the main trunk of the extratemporal portion.

Adult↗