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Biomedical subjects

Larry H Hollier

Publications and source records attributed to Larry H Hollier.

At least 19 recordsLinked to original sources
PubMed2006

Community-based, nonprofit organization-sponsored ultrasonography screening program for abdominal aortic aneurysms is effective at identifying occult aneurysms.

Early diagnosis of abdominal aortic aneurysm (AAA), prior to rupture, is vital for optimizing patient survival. An abdominal ultrasonography examination of an asymptomatic individual to check for the presence of an AAA, however, is not presently reimbursed by health insurance in the United States. This article reports the results of one nonprofit, community-based screening program, run by Aneurysm Outreach, Inc. (AOI; www.alink.org). AOI offered free screening for AAA to anyone who met the criteria of being (1) over 60 years old; (2) over 50 years old, male, and with positive family history for AAA; or (3) over 55 years old, female, and with positive family history for AAA. AOI organized 21 ultrasonographic screening events between September 2001 and November 2004, and the number of participants per event varied from 24 to 240. Altogether 3,088 individuals met the screening criteria and 22 of them were already known to have AAAs. Thirty-six (1.2%) individuals were excluded from the final analysis due to poor quality of the ultrasonographic images. Among the remaining 3,030 individuals, a dilatation of the aorta was detected and confirmed in 61 (2.0%) individuals, in 4.3% of the screened males and in 0.6% of the screened females. Thirteen individuals had their AAAs repaired surgically. The frequencies of males and current smokers were significantly higher in the AAA group than in the group with normal-size aorta (male AAA 83.6% vs. normal 42.0%, p < 0.0001; smoker AAA 54.9% vs. normal 18.1%, p < 0.0001). The mean age was significantly higher in the AAA group than in the group with normal-size aorta (AAA 71.0 +/- 6.2 vs. normal 68.4 +/- 7.0, p = 0.005). In conclusion, the results of this community-based free ultrasonographic screening program are in agreement with randomized controlled screening programs and emphasize the need for systematic screening programs and the importance of finding individuals harboring AAAs before their rupture.

Age Factors↗
PubMed2006

Single-stage total and near-total resection of massive pediatric head and neck neurofibromas.

Plexiform neurofibromas traditionally have posed a surgical challenge in pediatric patients. Expert preoperative planning, advanced surgical techniques, and vigilant postoperative care results in minimal morbidity and resolution of tumor symptomatology. A retrospective review of four consecutive pediatric patients with massive head and neck neurofibromas who underwent single-stage total or near-total removal of their tumors was performed. All four patients had obstructive airway symptoms. There were two minor complications. All patients had complete relief of their symptoms and return of function without any additional neurologic deficits. It is possible to safely achieve total or near-total removal of extensive plexiform neurofibromas with minimal morbidity while restoring lost function.

Adolescent↗
PubMed2006

Distraction rate and latency: factors in the outcome of pediatric mandibular distraction.

BACKGROUND: Distraction osteogenesis was initially devised as a way to lengthen the lower extremity. All the basic tenets of the technique were developed based on this use. This includes both the supposed need for a latency period before distraction begins (3 to 5 days) and the ideal rate of distraction (1 mm/day). There is no evidence that these values apply to craniofacial distraction osteogenesis, particularly in children. Indeed, with the markedly improved blood supply in the face when compared with the lower extremity and the use of the technique in children versus adults, one might assume that a shorter latency period and a more rapid rate of distraction are possible. METHODS: This study is a retrospective review of 22 pediatric patients with mandibular hypoplasia undergoing mandibular distraction osteogenesis. All patients were operated on by a team consisting of an oral surgeon and a plastic surgeon. All the distraction devices used were external. All patients had a latency period, before activation, of less than 24 hours and a distraction rate of 2 mm/day. RESULTS: Two patients developed cellulitis at the pin sites, one patient developed premature healing, one patient developed a nonunion that required further surgery. This was the only patient in the series who had distraction of a previous bone graft. No patient undergoing distraction of native mandible developed a nonunion. CONCLUSIONS: Eliminating the latency period and rapidly distracting the mandible in pediatric cases has an acceptably low complication rate. This benefits the patient in terms of an overall reduction in the amount of time that the child needs to remain in the distraction device. The patient spends less time with the distraction device, thus reducing the potential morbidity and increased cost of the treatment. Potential explanations for why this variation in distraction technique is successful include the improved blood supply in the face of children and the failure of external devices to translate all the distracted movements to the bone interface. Some of this force is translated into both bending of the pins and migration of the pins through bone. Although a latency period might be necessary in the distraction of the lower extremities, the application of this concept to the craniofacial skeleton in children is erroneous.

Age Factors↗
PubMed2006

Aneurysm Outreach Inc., a nonprofit organization, offers community-based, ultrasonography screening for abdominal aortic aneurysms.

Aneurysm Outreach Inc. (AOI; http://www.alink.org) is a nonprofit volunteer organization founded in 1999 whose aim is to (a) raise public awareness about aneurysms; (b) stimulate and fund genetic research through donations; and (c) coordinate a support network for aneurysm patients and their families. Since abdominal ultrasonography examination of an asymptomatic individual is not presently reimbursed by health insurance in the United States, one of the initiatives supported by AOI is to have free ultrasonography screening for abdominal aortic aneurysm (AAA) for those most at risk. One of the initiatives supported by AOI is to have free ultrasonography screening for abdominal aortic aneurysm (AAA). To meet this goal, a free screening program was initiated in September 2001 and by November 2004 approximately 3,000 participants were screened and 61 (2.0%) participants were confirmed to have a dilated aorta and were referred to their primary care physicians or vascular surgeons for further follow-up and treatment, if indicated.

Aortic Aneurysm, Abdominal↗
PubMed2005

International trends in the treatment of cleft lip and palate.

This article presents a contemporary (2004) survey of the methods and timing used in the care of cleft patients. The results are compared, when possible, with those of a similar study published by the lead author in 1998 and with those of the Eurocleft Project that took place from 1996 to 2000. Although very little uniformity is seen in the care of cleft patients, this comparison demonstrates a significant degree of agreement on many aspects of cleft care and a continuing process of adaptation and evolution in the field of cleft lip and palate surgery.

Child↗
PubMed2005

The management of frontal sinus fractures.

Management algorithms for frontal sinus fractures vary widely. Appropriate treatment depends on an accurate diagnosis, focusing on the physical examination and data from computed tomography scans. One must pay particular attention to involvement of the nasofrontal duct and violation of the posterior table because it is from these injuries that so much of the morbidity relating to these fractures is incurred. In large part, in the most severe injuries, a successful outcome is contingent upon meticulous removal of all visible frontal sinus mucosa with occlusion of the nasofrontal duct if required.

Frontal Sinus↗
PubMed2005

Rapid foot and calf compression increases walking distance in patients with intermittent claudication: results of a randomized study.

OBJECTIVE: The aim of our pilot study was to determine the usefulness of rapid, high-pressure, intermittent pneumatic calf and foot compression (IPCFC) in patients with stable intermittent claudication, with reference to the end points of improvement in initial claudication distance (ICD) (distance at which patient feels pain or discomfort in the legs), and improvement in absolute claudication distance (ACD) (distance at which patient stops walking because the pain or discomfort becomes severe). METHODS: Thirty male patients presenting with stable, intermittent claudication (ACD between 50 and 150 meters on treadmill testing at 3.8 km/h, 10 degrees gradient) were recruited into this pilot study from a single center. Fifteen patients were randomized to treatment with IPCFC (applied for 1 hour twice daily in the sitting position) and were also advised to have daily exercise, and 15 patients served as controls, who were advised exercise alone. All patients received aspirin and had resting and postexercise ankle/brachial index (ABI) measured at enrollment along with ICD and ACD on treadmill testing (3.8 km/h, 10 degrees gradient). The mean age, baseline ICD, and ACD of the treatment and control groups were 70.4 +/- 7 years and 70.7 +/- 9 years, 55.8 +/- 15 meters and 68.4 +/- 17 meters, and 86.7 +/- 19 meters and 103.9 +/- 27 meters, respectively. Both groups were equally matched for risk factors, including smoking, type II diabetes mellitus, and hypercholesterolemia. IPCFC was applied. The study protocol included follow-up visits at 1, 2, 3, 4, 6, and 12 months with the ABI, ICD and ACD being measured at every visit. RESULTS: The percent change from baseline for ICD and ACD for each patient visit and the mean +/- standard deviation (SD), standard error (SE), and median were calculated for the control and treatment groups. The percent change from baseline measurements (mean +/- SD) for ICD and ACD in the control group at 4, 6, and 12 months were 2.2 +/- 18 and 2.3 +/- 18, 2.9 +/- 17 and 5.2 +/- 20, and 3.6 +/- 18 and 5.8 +/- 20, respectively. In contrast, the changes in ICD and ACD at 4, 6, and 12 months in the treatment group were 137.1 +/- 128 (P < .01) and 84.3 +/- 82 (P < .01), 140.6 +/- 127 (P < .01) and 96.4 +/- 106 (P = .01), and 150.8 +/- 124 (P <0.01) and 101.2 +/- 104 (P <0.01), respectively. Although the ABI showed a slight increase in the treatment group, these differences were not statistically significant. CONCLUSIONS: The results of this pilot study show that IPCFC improves walking distance in patients with stable intermittent claudication. A significant increase in ICD and ACD was seen at 4 and 6 months of treatment, respectively, and the improvement was sustained at 1 year. The combination of IPCFC with other treatment such as risk-factor modification and daily exercise may prove useful in patients with peripheral arterial occlusive disease. It may be a useful first line of therapy in patients with disabling claudication who are unfit for major reconstructive surgery. Improved walking on long-term follow-up and experience from different centers may establish a role for this treatment modality in the future.

Administration, Oral↗
PubMed2005

Two hundred ninety-four consecutive facial fractures in an urban trauma center: lessons learned.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the different technical options available for repairing facial fractures. 2. Know which technical points facilitate performance of fixation of the facial skeleton by relatively inexperienced surgeons. 3. Have a basic understanding of the most common complications arising after facial fracture repair. 4. Have an understanding of how to avoid surgical complications following facial fracture repair. BACKGROUND: The treatment of facial trauma is associated with a myriad of potential complications. This may be compounded by the relative lack of compliance seen in the patient population within an urban trauma center and by the requisite involvement of residents in this care. METHODS: This study retrospectively evaluated 189 patients with a total of 294 separate fractures treated over a 3.5-year period. RESULTS: The overall rate of complications was 7.8 percent. CONCLUSIONS: The experience at a high-volume level I trauma center with residents as the primary physicians has confirmed that facial trauma surgery may be undertaken with an acceptably low complication rate. Numerous technical factors were thought to be responsible for this, including the use of miniplates for treatment in the majority of mandibular fractures, overcorrection of orbital volume in fractures involving the globe, and the use of a transconjunctival incision with a lateral canthotomy for access to the lower eyelid structures.

Adult↗
PubMed2005

Assessing the long-term retention and permanency of acellular cross-linked porcine dermal collagen as a soft-tissue substitute.

BACKGROUND: Acellular porcine dermis has been used as a soft-tissue substitute in Europe since 1998 and in the United States since 2000. Processing renders the composite acellular, reducing antigenicity and crosslinking the dermal collagen. The purpose of this study was to determine the long-term histologic response of this material to the transfer into a subcutaneous soft-tissue location in an in vivo mouse model. METHODS: A total of 24 mice (ICR strain) underwent an initial procedure transplanting a segment of acellular porcine dermis into a dorsal subcutaneous pocket. The implants were examined for qualitative characteristics including rigidity, migration, inflammation, and healing response. Composites of skin, subcutaneous tissue, implant, and underlying muscle were harvested for histologic evaluation. The specimens were analyzed for inflammatory response, degree, and character of tissue incorporation and degree of implant resorption. RESULTS: One of the 24 animals studied experienced extrusion of the implant. The remaining 23 implants persisted within their respective hosts until the time the animals were killed. The volume and weight of all of the implants remained unchanged from the preoperative to postoperative measurements. Dystrophic calcification and bone formation was seen at 12 months. CONCLUSIONS: The results do not suggest characteristics optimal for implants used in soft-tissue augmentation for the purpose of aesthetics. The porcine dermis would appear from these results to be better suited for situations that require strength and permanence of the implant.

Animals↗
PubMed2005

Circumferential negative-pressure dressing (VAC) to bolster skin grafts in the reconstruction of the penile shaft and scrotum.

This paper presents 4 consecutive cases using negative-pressure dressings (VAC) to bolster skin grafts in male genital reconstruction. In this series reconstruction followed 1 case of tumor ablation and 3 cases of debridement of abscesses or Fornier's gangrene. The VAC was applied circumferentially to the penis to secure skin grafts either directly to the penile shaft or to facilitate skin grafting to the scrotum. Graft areas ranged from 75 to 250 cm. All cases resulted in successful genital wound coverage; minor complications are described. Three practical points are brought forth. First, the VAC facilitates skin grafting to the complex contour of male genitalia. Second, the VAC can be applied circumferentially to the penis without the need for perfusion monitoring or fears of avascular necrosis. Third, with the use of the VAC, bolster use can likely be discontinued as early as 72 hours with good graft adherence and survival.

Bandages↗
PubMed2005

The identification of mandible fractures by helical computed tomography and panorex tomography.

The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation of patients who have experienced trauma. However, panoramic tomography (PT) continued to be superior in sensitivity to CT in the identification of mandible fractures and has been considered the gold standard for the past 3 decades. In 1989, a faster, higher-resolution spiral or helical CT (HCT) became widely available, and its efficacy in multiplanar evaluation and diagnosis of fractures of the upper two thirds of the face has been well established. The sensitivity of this new-generation HCT in comparison to PT in the detection of mandible fractures has not been determined. The purpose of this study was to compare the sensitivity, physician interpretation error, and interphysician agreement of HCT and PT in the identification of mandible fractures. The number and anatomical location of mandible fractures identified by HCT and PT was not significantly different. However, the number and location of 96% of fractures identified by HCT was agreed on by neuroradiologists compared with only 91% of fractures identified by PT. Furthermore, the interphysician agreement when no fracture was identified was 96% by HCT versus only 81% by PT. In conclusion, HCT has enhanced imaging quality, equivalent sensitivity in identification of fractures, decreased interpretation error, and greater interphysician agreement in the identification of mandible fractures. HCT has surpassed PT as the current gold standard for the radiographic evaluation and diagnosis of mandible fractures.

Humans↗
PubMed2004

Endovascular aortic aneurysm repair in the octogenarian: is it worthwhile?

HYPOTHESIS: During the past decade, endovascular stent graft repair (EVSG) of abdominal aortic aneurysms has emerged as a less invasive and less morbid alternative to open surgical repair. We hypothesize that EVSG may become the treatment method of choice among patients older than 80 years. DESIGN: Retrospective case series. SETTING: Major academic medical center with extensive experience in endovascular and open aortic aneurysm surgery. PATIENTS AND METHODS: During a 5-year period, EVSG was performed in 595 patients at our institution. One hundred fifty (25.2%) of these patients were older than 80 years. Our prospectively acquired database was reviewed with respect to the demographic, intraoperative, and outcome data of this elderly population. MAIN OUTCOME MEASURES: Technical and clinical success, aneurysm-related events (aneurysm-related death, type I or type III endoleaks, aneurysm expansion, or aneurysm rupture), and secondary interventions. RESULTS: There were 119 men (79.3%) and 31 women (20.7%) (mean age, 84.6 years). Mean aneurysm diameter was 6.7 cm. Comorbidities including chronic obstructive pulmonary disease, coronary artery disease, chronic renal insufficiency, peripheral vascular disease, hypertension, and hypercholesterolemia were common in these patients, with an average of 2.9 comorbid conditions per patient. Mean follow-up was 16.9 months (range, 1.0-61.4 months). One hundred forty-six patients (97.3%) received only regional anesthesia, and the average intraoperative blood loss was 369 mL. Average hospital and intensive care unit stays were 2.5 days and 0.1 day, respectively. The procedure was performed emergently in 3 patients, and each recovered uneventfully. There were 5 aborted procedures (3.3%) for technical reasons and 4 conversions to open aortic repair (2.6%). In addition to these aborted procedures, there were 2 additional technical failures resulting in a technical success rate of 95.3%. Endoleaks were common and included 9 type I (6.90%), 35 type II (24.10%), and 1 type III (0.69%). The majority either resolved spontaneously (type IIs) or with minimally invasive secondary intervention, which was performed in 13 patients. Perioperative local/vascular and systemic complications occurred in 16 (10.7%) and 8 (5.3%) patients, respectively. There were 5 perioperative deaths (3.3%)(<30 days postoperatively). Forty late deaths (26.7%)(>30 days postoperatively) occurred, which were unrelated to the EVSG procedure. CONCLUSIONS: Endovascular repair of abdominal aortic aneurysms can be performed safely and successfully in the majority of octogenarians with relatively low complication rates. Improved EVSG devices and operator experience may make this procedure the treatment method of choice for patients in this age group who meet specific anatomical criteria.

Age Factors↗
PubMed2004

Multicenter randomized prospective trial comparing a pre-cuffed polytetrafluoroethylene graft to a vein cuffed polytetrafluoroethylene graft for infragenicular arterial bypass.

Poor patency of synthetic grafts for infragenicular revascularization has led to use of distal vein patches or cuffs. The aim of this study was to compare the distally widened Distaflo PTFE graft, which mimics a vein cuff, with a PTFE graft with distal vein modification. In this prospective, randomized, multicenter trial we compared use of a precuffed PTFE graft wit that of PTFE grafts with distal vein modification for infragenicular revascularization in patients with critical limb ischemia without saphenous vein. Study end points were primary and secondary patency and limb salvage rates at 2 years. From January 28,1999 to November 1, 2000, 104 patients were enrolled in 10 North American centers. Thirteen were excluded for protocol violation. Ninety-one bypasses were performed in 89 patients with a mean age of 73 years (range 47-90). By randomization, 47 bypasses were done with the precuffed graft and 44 with PTFE graft with vein cuff. Both groups were comparable for comorbidities and operative variables, except for a higher incidence of acute ischemia in the precuffed group (19% vs. 4.5%, p = 0.03). Bypass was a redo procedure in 53% and was performed at the infrapopliteal vessels in 79%. Operative mortality was 2.2% (2/91). Mean follow-up was 14 months (range 1-30). At 1 and 2 years, primary patency was 52% and 49% for the precuffed group and 62% and 44% for the vein cuffed group, respectively (p = 0.53). At 1 year and 2 years, the limb salvage rate was 72% and 65% for the precuffed group and 75% and 62% in the vein cuffed group (p = 0.88). Although numbers are small and follow-up short, this midterm analysis shows similar results for the Distaflo precuffed grafts and PTFE grafts with vein cuff. A precuffed graft is a reasonable alternative conduit for infragenicular reconstruction in the absence of saphenous vein and provides favorable limb salvage.

Aged↗
PubMed2004

The use of hydroxyapatite cements in craniofacial surgery.

Hydroxyapatite cements are a useful adjunct in treatment of deficiencies of the craniofacial skeleton. They provide a rapid and reliable method of correcting bony defects or contour deformities. Although they are alloplastic, their high degree of tissue tolerance and their demonstrated ability to incorporate within host bone make problems such as infection and extrusion rare. As with any alloplast, sound surgical principles should be used to avoid these complications. There should always be an acceptable overlying soft tissue envelope and minimal contamination of the operative site. Theoretical concerns about potential growth disturbance have not been borne out in experimental studies or by clinical experience.However, more extensive follow-up of patients will be needed to resolve these issues.

Animals↗
PubMed2004

Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report.

Iatrogenic aortic injuries after spinal surgery have been described, but are rare. We describe a case of a 77-year-old woman who underwent surgical correction of a debilitating spinal deformity at an outside institution. Postoperative thoracic spine radiographs and computed tomography scans revealed a misplaced pedicle screw at T5, which was impinging on the descending thoracic aortic wall. The patient was brought to the operating room, where a thoracic stent graft was deployed under fluoroscopic guidance as the malpositioned screw was manually retracted. The patient had an uneventful postoperative course, and was discharged within 24 hours. This case represents a rare but potentially morbid vascular complication of spinal instrumentation surgery that was successfully treated without the need for thoracotomy.

Aged↗
PubMed2004

The role of surgical revascularization in the management of diabetic foot wounds.

Diabetic foot wounds affect an estimated 15% of all patients with diabetes. These wounds are typically multifactorial in origin. Neuropathy of the foot and impaired wound healing are frequently associated with peripheral arterial occlusive disease. These factors combine to contribute to the development of foot ulcers. Successful wound healing and limb salvage require prompt recognition and treatment. Assessment of arterial perfusion is imperative and may be accomplished by a combination of physical examination and noninvasive vascular laboratory studies. When associated with significant ischemia, diabetic foot ulcers require arterial revascularization to achieve wound healing.

Diabetic Foot↗
PubMed2004

Detailed protocol of ischemia and the use of noninvasive vascular laboratory testing in diabetic foot ulcers.

Diabetic foot ulcers are frequently complicated by the presence of arterial occlusive disease (PAD). It is often difficult to assess the severity of ischemia by history and physical examination alone; a combination of different types of noninvasive laboratory testing may be necessary. Pulse-volume recordings and segmental pressures should be routinely obtained. If questions persist, an anatomic study is warranted. Duplex ultrasonography can provide accurate information with little risk to the patient and so should be readily obtained.

Diabetic Foot↗