Biomedical subjects
Publications and source records attributed to J H Palmer.
The closure of a large palatal fistula with a free fascial forearm flap based on the radial vessels is described. The benefits of this flap are discussed with particular reference to this site.
This study compares the attitudes and beliefs of white and black adolescents who drink heavily. The study's sample comprises 1,533 youth who responded in 1987 to a survey of 10,259 7th to 12th grade students, and reported that they had gotten drunk at least six times within the previous year. The ratio of blacks to whites decreased with drinking severity. Controlling for age, sex, and living situation, a logistic regression revealed that blacks were significantly more likely than whites to believe that getting drunk would lead to health problems and that alcohol is addicting. Blacks were also more concerned than whites about their parents' disapproval of their drinking alcohol, while whites were more concerned than blacks about their friends' disapproval. The study suggests that programs targeted towards black youth who drink heavily should focus less on enhancing peer refusal skills and more on ensuring that black parents and other adults make explicit their negative attitudes towards alcohol use.
We describe our experience with the true island pectoralis major musculocutaneous flap in patients with high-volume defects for whom free-tissue transfer is unsuitable. Our operative technique is presented. We have modified the method of making a true island of the pectoralis major musculocutaneous flap on a muscle-free pedicle as first described by Wei et al. in 1984. This maintains maximal donor-site muscle function and facilitates closure of the donor-site defect. We present our results in 24 patients, in whom the flap has proved to be robust and reliable. The flap's advantages in terms of increased pedicle length, wider arc of rotation, decreased pedicle bulk, and improved cosmesis of the reconstruction are discussed.
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Because crack use is such a recent phenomenon, little is known about users of this highly addictive drug, the harmful effects of which have been widely publicized. This study hypothesized that crack users would be more depressed and more alienated from family, friends, and school staff than would cocaine users, and would consider as less important reasons not to use crack and cocaine. The authors compared 411 users of cocaine (but not crack) to 156 crack users, all but 22 of whom had also used cocaine. The sample was derived from a larger random survey of 7th- through 12th-grade students in North Carolina. Results indicated that crack users were younger than cocaine users, made poorer grades, were more depressed, and were more likely to be alienated from family and friends. However, cocaine and crack users were equally unlikely to confide in anyone in their school if they had a drinking or drug problem. Further, crack users were more likely to have talked once to a teacher or counselor in the past year about their problems. The implications of these seemingly inconsistent findings are explored. Crack users appear to be a particularly vulnerable population.
During spring 1987, North Carolina conducted a drug prevalence survey on a randomly selected, stratified cluster sample of 10,259 seventh-12th grade students enrolled in public schools. The survey assisted in development of new drug prevention programs funded by the Drug-Free Schools Act of 1986. Results indicated alcohol, tobacco, and marijuana were the most commonly used drugs; males and whites were more frequent users than females and blacks; and almost 20% of 11th and 12th grade students reported coming to school drunk in the year preceding the survey. Extensive use of wine coolers and smokeless tobacco was noted. The need is discussed for other states to conduct similar surveys to establish a data base from which better programming decisions can be made.
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The blood supply to the skin and underlying tissues was investigated by ink injection studies, dissection, perforator mapping and radiographic analysis of fresh cadavers and isolated limbs. The results were correlated with previous regional studies done in this department. The blood supply is shown to be a continuous three-dimensional network of vessels not only in the skin but in all tissue layers. The anatomical territory of a source artery in the skin and deep tissues was found to correspond in most cases, giving rise to the angiosome concept. Arteries follow closely the connective tissue framework of the body. The primary supply to the skin is by direct cutaneous arteries which vary in calibre, length and density in different regions. This primary supply is reinforced by numerous small indirect vessels, which are "spent" terminal branches of arteries supplying the deep tissues. An average of 374 major perforators was plotted in each subject, revealing that there are still many more potential skin flaps. Our arterial roadmap of the body provides the basis for the logical planning of incisions and flaps. The angiosomes defined the tissues available for composite transfer.
A prospective survey was conducted of all patients requiring admission to the Regional Burns Centre for South East Scotland at Bangour Hospital and the Royal Hospital for Sick Children in Edinburgh. All patients admitted between May 1983 and April 1984 were studied. Details were obtained about the cause and extent of the burn, the immediate first aid measures provided, causes for delay in arrival at the Burns Centre and, when appropriate, the initial care and its adequacy before transferring the victim from another hospital. A total of 276 patients were studied, of whom 152 were transferred. Early management by referring hospitals was often far from ideal, with errors in initial care that should have been avoided.
This study has investigated the action of two commonly available preservatives, chlorbutol and chlorocresol, on fresh cadaver tissue. If the arterial system of the subject is perfused first with either preservative then the progression of tissue necrosis can be delayed for up to 1 month. The preservative can be combined with the lead oxide-gelatin mixture described by Rees and Taylor without compromising the results of radiographic studies. Both chlorocresol and chlorbutol have the advantage over formalin of retaining the normal colour and texture of the tissues. A regimen is suggested which has all of the advantages of the mixture originally described by Salmon, but is much simpler and cheaper to produce. It has proved successful when used in whole cadavers but the visceral contents must be removed at an early stage.
A series of 31 fresh cadaver injection, dissection and radiographic studies were undertaken to define the vascular architecture of the anterior chest wall and to correlate the findings of previous writers in this area. The findings confirmed that the dominant supply to this region is from the internal thoracic artery which interconnects in all layers with the posterior intercostals, the lateral thoracic, the acromio-thoracic and the transverse cervical arteries. The dominant cutaneous perforators of these vessels are concentrated around the perimeter of the pectoralis major muscle, the costal margin and over the interdigitations of the serratus anterior muscle in the mid-axillary line. The clinical significance of these findings is discussed with particular reference to the design of various breast reduction procedures and the planning of flaps in this area. Of special note is the observation that the concentration of large perforators which exists along the inframammary crease arises from the anterior intercostal vessels in the fifth and sixth intercostal spaces.
The importance of an accepted method of assessment of the long term results of unilateral cleft lip repair is recognised. A series of 20 children was assessed by two separate panels of judges, using standardised clinical follow up photographs, and their results compared. One of the panels made a second assessment of the 20 children. The method was tested statistically for intra- and inter-observer reliability and was found to be reproducible. Such a method may have a place in comparing the long term results of different surgical techniques of cleft lip repair.
It has been suggested that delay between expansion and insertion of the definitive prosthesis in breast reconstruction reduces the incidence of adverse capsular contracture. We have carried out a prospective trial to examine this hypothesis. 65 patients were randomly allocated into two groups; in one, insertion of the definitive prosthesis was 2 weeks following expansion ("immediate") and in the other, 6 months ("delayed"). The incidence of adverse capsular contracture assessed both by the Baker Scale and a linear analogue scale showed no difference between the two groups. A new objective method for measuring ptosis using a specially designed template is described. The degree of ptosis was not affected by the delay.