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Biomedical subjects

J M Hiebert

Publications and source records attributed to J M Hiebert.

At least 19 recordsLinked to original sources
PubMed1997

Decreased receptivity of pathway connective tissue to sympathetic nerve ingrowth in the developing rat.

Sympathetic axons can form atypical pathways to denervated orbital targets in neonatal rats but not in rats aged 30 or more days. The objective of this study was to determine if connective tissue pathways that carry sympathetic nerves lose their ability to sustain axonal sprouting during the early postnatal period. Regions of periorbital sheath known to contain large numbers of sympathetic axons that travel to distal orbital targets were excised from rats (sympathectomized 3 days previously) on postnatal days 6-7, 14-15, 30-31, and 48-49 and placed in anterior chambers of adult host rats. Tissues were removed 3, 6, or 10 days post-transplant and sympathetic ingrowth was analyzed by catecholamine histofluorescence in whole-mount or cryosectioned specimens. Connective tissue transplants from 6-15-day-old donors showed significant fiber ingrowth by 3 days in oculo, and innervation was maximal by 6 days. In contrast, sprouting into 30-49-day-old tissue was significantly slower, with most transplants lacking fibers at 3 days, and with small numbers of short fibers present at 6 days. We conclude that maturational changes occur in periorbital connective tissue pathways in the early postnatal period which make them less receptive to ingrowth by sympathetic nerves. The findings that connective tissue pathways are better substrates for sympathetic sprouting in the neonatal rat supports the view that developmental changes in these tissues are likely to contribute to the impaired reinnervation of orbital targets by contralateral neurons in juvenile and adult rats.

Aging↗
PubMed1994

Effects of argon beam coagulation on split thickness skin graft survival in the swine model.

Argon beam coagulation (ABC) uses argon gas to evacuate blood in an operative field and simultaneously to transport a coagulating electric current to bleeding sites. This allows a 'no touch' method of coagulation which is faster, more precise, and less destructive than conventional electrocautery. The technique has been used to reduce blood loss in liver surgery, trauma surgery and neck dissections. In this study, the effect of ABC treatment of the recipient graft beds on the survival of split thickness skin grafts was assessed in pigs, testing the hypothesis that ABC treatment of the recipient bed would have no adverse effect on skin graft survival. Nine 20 kg mixed breed pigs had split thickness skin grafts raised on each side of the paraspinous area. The graft beds on one side were prepared using ABC and the contralateral side served as controls. The percentage of graft survival on the ABC treated sides was compared to control graft survival on the other side at 12 days postsurgery. Our results confirm the hypothesis that treatment of the recipient bed with ABC does not adversely affect the survival of split thickness skin grafts.

Animals↗
PubMed1994

Facial Impairment Scales for Clefts.

The purpose of this paper is to present the Facial Impairment Scales for Clefts. The Facial Impairment Scales for Clefts consist of four, 24-photograph, empirically derived scales of severity of cleft impairment. They were developed (1) to serve as research tools in single and multicenter studies of the surgical, psychosocial, and integrated treatment outcomes of facial clefts and (2) to assist in clinical assessment staging of the aesthetic severity of cleft impairment. Study 1 was conducted to extend the generalizability of the Facial Impairment Scales for Clefts to other groups of raters, including plastic surgeons. Reliability of scale ratings between children (n = 54) and plastic surgeons (n = 23) was examined. Rank orders of photographic subjects by severity of cleft impairment by children were highly correlated with ranks given by plastic surgeons. Study 2 in this series was conducted to assess if new photographs could be reliably fitted to scales. One-hundred and thirty-four medical student raters were able to scale new photographs reliably to the standard measures. These findings suggest that the Facial Impairment Scales for Clefts have sufficient reliability and validity for use in studies of severity of facial impairment.

Adolescent↗
PubMed1993

Congenital nonprogressive myopathy with Möbius and Robin sequence--the Carey-Fineman-Ziter syndrome: a confirmatory report.

Recently, we evaluated a 27-month-old boy with congenital generalized nonspecific myopathy, Möbius sequence, Robin sequence, and failure to thrive. We think the child has the same entity described by Carey, Fineman, and Ziter in 1982 [J Pediatr 101:353-364] and as such represents only the third example of this unusual syndrome. Review of the large number of conditions in which the Robin sequence occurs supports heterogeneity. Our case strengthens the Möbius-Robin association and further defines the Carey-Fineman-Ziter syndrome as a viable entity. It is most likely inherited as an autosomal recessive trait.

Abnormalities, Multiple↗
PubMed1993

Comparison of rapid versus slow tissue expansion on skin-flap viability.

The effect of rapid versus slow tissue expansion on random-pattern skin-flap survival lengths was evaluated in two groups of pigs. Each group (group 1--slow; group 2--rapid) was further evaluated for the effect that delay (A), delay plus expansion (B), expansion only (C), and acute flap elevation (D) had on flap length viability. Intergroup and intragroup comparisons were made. In the slowly expanded group, significantly greater flap length viabilities were demonstrated in the slow expansion flaps as compared with the delay plus expander flaps and the delayed flaps, respectively. In the rapidly expanded group, the flap length viabilities of flaps C, B, and A were statistically equal. However, the flap length viability of the rapidly expanded flaps was statistically equal to that of the slowly expanded flaps (C1 = C2). The effect tissue expansion has on improving flap length viability as compared with the delay phenomenon may be related to the combination of a delay effect plus increased nutrient flow density that slow expansion produces. This combined metabolic enhancement is preserved with rapid tissue expansion.

Animals↗
PubMed1993

Combined effects of severity of cleft impairment and facial attractiveness on social perception: an experimental study.

Children and adolescents provided their impressions of stimulus faces that systematically varied in attractiveness and severity of cleft impairment. The results indicated that facial attractiveness is a consistent characteristic of cleft-impaired faces. However, facial attractiveness did not moderate the negative impact of cleft impairment on social perception. Reduced severity of impairment did moderate the negativity of social perception. The implications of these findings for our understanding of the effects of cleft impairment on social perceptions are discussed.

Adolescent↗
PubMed1993

Clefting and psychosocial adjustment. Influence of facial aesthetics.

This article briefly reviewed the research literature on the psychosocial correlates of facial clefts and described a program of research to study the relationship between severity of cleft impairment and psychosocial adjustment. In the past 40 years, there has been increasing recognition and research literature on the psychologic implications of facial clefts to patients and their families. Advances in both the knowledge base and the science of the psychologic correlates of facial clefts have been made. Children with clefts are not at greater risk for psychopathology than are individuals without clefts; however, they are at significant risk for social competence problems relating to development of friendships, progress in school, and participation in organizations. Problems with social competence have a negative effect on development. The ability of all children to make friends and to be liked by others is considered by most parents, teachers, and child development specialists to be a major developmental milestone. Not having friends and social withdrawal can cause parents or teachers to refer noncleft children to mental health professionals and is a predictor of impaired adult social competence and mental health. Studies of adults with clefts are consistent with studies of adults without clefts. Adults with repaired clefts are less likely to marry than are their noncleft siblings, and they have more problems with social withdrawal. Because facial attractiveness is well-known to affect peer acceptance, we hypothesized that the severity of the cleft deformity may have a significant impact on social competence. Consequently, we undertook a program of research to examine this question.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1991

Development of scales of severity of facial cleft impairment.

The reliability and validity of human judgments in rating the severity of cleft-related facial impairment were examined in this series of studies. The goal of the research was to develop scales for rating the severity of facial cleft impairment using psychophysical methods for measuring human judgment. The principle findings were: (1) Four photographic categorized scales with high inter-group reliability and satisfactory content and construct validity were developed; (2) Raters used objective stimulus characteristics of the face to scale impairment; (3) Ratings of facial attractiveness decreased as the severity of impairment increases; (4) Full face ratings of the severity of impairment correlated highly with ratings of the same photographs cropped below the eyes. The implications of these findings for clinical and research application are discussed.

Adolescent↗
PubMed1989

Postburn heterotopic ossification: insights for management decision making.

An analysis of 1,478 consecutive admissions to the University of Kansas Burnett Burn Center revealed 18 patients who developed heterotopic ossification (1.2% incidence). Seventeen patients developed this disease in the elbows; one patient had shoulder involvement. Two patients eventually developed bilateral elbow disease. All patients initially presented with pain and limitation of joint motion. The diagnosis was then confirmed radiographically. All patients suspected of heterotopic ossification received physical therapy consisting of active range of motion only. Ten patients responded to conservative treatment and regained functional range of motion, and eight patients developed refractory ankylosis requiring surgical management. All surgically managed patients achieved a functional range of motion with an average followup of 35.0 months.

Adult↗
PubMed1988

Reliability of esthetic ratings of cleft impairment.

The decision to seek secondary treatment for facial clefts is often the result of concerns about the esthetic acceptability of appearance. There are no standard techniques to assess cleft impairment for esthetic acceptability. Therefore, it is not possible to evaluate objectively either the need for or the benefits of treatment. If it could be shown that people agree closely on how they rate the esthetic appearance of cleft impairments that vary in severity, then esthetic measures of cleft impairment could be developed with human judgment as the yardstick. The goals of this study were: (1) to examine the reliability with which children express their preferences for cleft impairments that vary in severity, (2) to determine if other facial characteristics influence the reliability of children's preferences for cleft impairments, and (3) to evaluate if age and gender of children influence preferences for cleft impairments. Based on preratings, eight types of photographic slides were created that varied in severity of cleft impairment and global facial attractiveness. A second sample of subjects then rated the slides on the esthetic acceptability of appearance. Children ranked the photographic types consistently. They least preferred the photographic types depicting severe impairment or low facial attractiveness, or both, and most preferred faces with no impairment or moderate attractiveness, or both. There were also developmental effects in that younger children tended to have less consensus in their ratings of appearance than older children. Finally, boys displayed greater consensus than girls.

Adolescent↗
PubMed1987

Type of facial cleft, associated congenital malformations, and parents' ratings of school and conduct problems.

Parents' ratings of conduct and school problems were evaluated in 79 subjects with palatal clefts. Subjects were divided into four groups consisting of: (1) unilateral complete clefts of the lip and palate (UC Group); (2) unilateral complete clefts of the lip and palate with associated congenital malformations (UC-C Group); (3) cleft palate only (CPO Group); and (4) cleft palate only with associated congenital malformations (CPO-C Group). Comparisons between groups suggested that subjects with associated congenital malformations, whether or not they had UC or CPO, tended to have more serious school and conduct problems when compared to children with clefts and no associated congenital malformations. The association of congenital malformations with a cleft lip and palate increased the risk of reported conduct problems at home and behavioral and learning problems at school.

Abnormalities, Multiple↗
PubMed1986

Fluid resuscitation of the thermally injured patient. Current concepts with definition of clinical subsets and their specialized treatment.

The key to successful fluid resuscitation of the thermally injured patient is close monitoring of the clinical response. Individualized resuscitation based on the parameters described allows for approximation of this goal. An eclectic approach used by the authors has been described with reference to clinical subsets that may require specialized resuscitative methods. Efforts should be made to use the smallest volume of fluid needed to optimize end organ perfusion. The goals of fluid resuscitation have been summarized and a variety of formulas have been described. We anticipate that our understanding of patient subsets outlined in this paper will undergo further evolution.

Adult↗
PubMed1985

Burns and adjustment to injury: do psychological coping strategies help?

The effects of teaching patients strategies for coping with the pain of an acute burn injury and its treatment were investigated. Twenty patients with comparable burn injuries and admitted to a Burn Center were randomly assigned to either a control or experimental group. Experimental patients received systematic instruction on how to cope with the pain and stress of burn injury; control patients received standard information and social support only. Results showed that experimental patients reported less pain and greater sense of psychological well-being and control over the outcome of their injuries than did control patients. Moreover, experimental patients went home, on the average, more than 1 week sooner than did control patients. The implications of these findings for the improved care of patients with burn injuries and the economics of burn care are discussed.

Adaptation, Psychological↗
PubMed1984

Parents' tolerance for the conduct problems of the child with cleft lip and palate.

A standardized questionnaire was used to record parents' ratings of the frequency of conduct problems and their tolerance of the problems. According to parent report, children without facial clefts and children with facial clefts displayed conduct problems with about the same frequency. However, parents of children with facial clefts were significantly more tolerant of problems in their offspring. These data suggest that the social learning environments in the homes may be different for the two groups of children.

Adult↗
PubMed1981

The use of Tc-99m MDP bone scanning in the study of vascularized bone implants: concise communication.

The extent to which the nutrient artery alone is capable of maintaining bone growth in the immature animal was studied by excision and reimplantation of the upper tibia in two groups of puppies. In one group the reimplant was totally devascularized, and in a second group attempts were made to preserve the nutrient vessels to the reimplant. Technetium-99m methylene diphosphonate (Tc-99m MDP) was used to assess the effectiveness with which the nutrient circulation was maintained. With one exception the Tc-99m MDP scans proved to be reliable in indicating the potential for continued growth after reimplantation. It was found that the nutrient artery alone is capable of maintaining longitudinal bone growth in metaphyseal reimplants in immature animals. Complete devascularization results in cessation of growth. The Tc-99m MDP bone scan should prove of critical importance in the assessment of free vascularized transplants of immature bone.

Animals↗