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Biomedical subjects

J H Cochran

Publications and source records attributed to J H Cochran.

12 recordsLinked to original sources
PubMed1983

The magnum procedure: surgical salvage of end-stage velopharyngeal incompetence.

One of the most difficult problems in cleft palate surgery is the patient who remains velopharyngeally incompetent after previous attempts at surgical correction. The magnum procedure was employed as a method of surgically salvaging these problem patients. The magnum flap is a procedure involving the use of a single or double hemipalatal flap based on the greater palatine vessels and inserted posterior to the hard palate to provide a maximum pushback in these patients. Eleven cases of severe and persistent velopharyngeal incompetence secondary to cleft palate after prior palatoplasty and secondary procedures are presented. All these patients had had at least two previous palatal procedures and were not considered good candidates for significant improvement by further speech therapy, based on evaluation in the Speech Pathology Department. All patients had preoperative and postoperative speech evaluations, including nasal airway studies and cineradiography. Postoperative follow-up was between 12 and 66 months. Speech evaluations and results and operative details and complications were investigated. All patients had mild to marked improvement in their velopharyngeal function, articulation, and resonant voice quality. There were two perioperative complications, one of which was a delayed bleeding episode requiring no treatment and the other of which was a case of cellulitis of the cheek requiring additional antibiotics. Based on this initial series of patients, we feel that the magnum procedure offers considerable promise in the salvage of those patients previously falling into the category of end-stage velopharyngeal incompetence.

Adolescent↗
PubMed1981

Hypoplasia of the latissimus dorsi muscle complicating breast reconstruction in Poland's syndrome.

Poland's syndrome includes anomalies of the breast, thorax, and upper extremity. Unilateral hypoplasia of the breast and pectoral muscle are seen most frequently, and the resulting problem of breast reconstruction must be addressed. The latissimus dorsi myocutaneous flap is one of the most useful reconstructive tools in this situation. A case is presented of Poland's syndrome with hypoplasia of the latissimus dorsi muscle-an abnormality not generally associated with Poland's syndrome. The latissimus dorsi muscle should be carefully evaluated preoperatively in such patients, to make sure it is adequate for reconstructing the absent breast and pectoral muscle.

Adult↗
PubMed1981

Usefulness of the innervated tensor fascia lata flap in paraplegic patients.

Pressure sores in paraplegic patients are a well-known problem. Such patients can develop pressure necrosis and skin breakdown in spite of preventive measures and adequate surgical management. The occurrence and recurrence of these problems is due in large part to the patient's inability to perceive pressure discomfort in the insensible sitting area. Use of the innervated tensor fascia lata flap has great value in selected patients. A series of 9 patients is presented. In all patients, postoperative sensibility in the flap was maintained as in the preoperative stage. Follow-up of these patients shows that all flaps have remained healed and functioning The neuroanatomical features of the innervated tensor fascia lata flap make it a promising method for covering pressure sores and avoiding subsequent complications.

Fascia↗
PubMed1981

Combined use of vascular bypass and myocutaneous flap reconstruction in salvage of an ischemic limb.

Successful limb salvage and rehabilitation were achieved in a patient with chronic ischemia and a deep tibial ulcer by combining arterial reconstructive surgery with myocutaneous flap coverage of the defect. Without adequate and expeditious soft tissue coverage, recovery would have been prolonged, and the likelihood of successful rehabilitation would have been seriously jeopardized.

Chronic Disease↗
PubMed1980

A method for temporary reconstitution of the cervical esophagus.

A simple method of temporary reconstitution of the cervical esophagus in major head and neck surgery is detailed in a case report. Accompanying diagrams illustrate the mechanics of inserting a number 26 nasopharyngeal airway from the hypopharynx to the esophagus. This arrangement simplifies the management of oral secretions until permanent reconstruction of the cervical esophagus can be accomplished.

Carcinoma, Squamous Cell↗
PubMed1980

Metastasis in head and neck cancer, 1979.

Metastatic spread of head and neck cancer signifies a grave change in prognosis for the patient. The presence or absence of detectable metastasis is valuable knowledge both in planning treatment and in predicting prognosis. Knowledge of the metastatic behavior patterns of such tumors, and of the diagnostic means of detecting metastasis, is essential. The available knowledge on this problem is comprehensively reviewed to present, in a single source, the requisite knowledge for any physician treating head and neck cancer. Metastatic spread is reviewed according to incidence, detection methods, anatomical sites, and correlation with characteristics of the primary tumor. Finally, methods of detecting metastasis are reviewed and a practical approach to patient evaluation recommended.

Bone Neoplasms↗
PubMedDate not supplied

Tinnitus as a presenting symptom in pernicious anemia.

An unusual case presenting to the otolaryngologist as pulsatile tinnitus is discussed. Fowler points out that the circulatory response to anemia is increased cardiac output. There is associated tachycardia and increased arterial pulse pressure. Because of this increased flow state and turbulence, systolic bruits, venous hums, and "capillary" pulsations are found. This increased flow state is perceived in the ear as a transmitted pulsatile tinnitus. The successful treatment of this patient's pernicious anemia corrected the hyperdynamic circulatory state, and resulted in disappearance of her tinnitus.

Anemia, Pernicious↗
PubMedDate not supplied

Angiosarcoma of the head and neck.

Angiosarcomas are uncommon tumors of the skin and soft tissues, but occur in endothelial cells of almost any internal organ. When they occur in the skin, the head and neck are the most common sites of origin. Nothing is pathognomonic about their clinical presentation, and the pathologic diagnosis can only be established by biopsy. The frequent multicentric nature of the tumor and propensity for extensive subcutaneous spread require wide treatment fields, whatever the modality of therapy, and account for the low survival reported. Four cases and their outcome are reported, with only one patient achieving an apparent cure following irradiation therapy. Based on experience and extensive review of the literature, a best therapeutic approach cannot be recommended. Since the outlook for cure is so unfavorable, there appears to be a need for cooperative studies using surgery, irradiation, and perhaps, chemotherapy.

Aged↗