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Biomedical subjects

M J Timmons

Publications and source records attributed to M J Timmons.

At least 19 recordsLinked to original sources

Speech after repair of isolated cleft palate and cleft lip and palate.

The speech of children with isolated cleft palate (CP) repaired by one surgeon has been compared with the speech of children with some form of unilateral cleft lip and palate (CLP) repaired by the same surgeon. All palate repairs included an intravelar veloplasty. We identified 57 children (5--12 years old) with cleft palates repaired in infancy, of which three patients with other medical problems were excluded. Of the 54 patients, 44 (81%) attended for review (27 CP, 17 CLP). Video recordings were analysed by two speech and language therapists, using the Cleft Audit Protocol for Speech. The CP patients had no evidence of permanent fistulas. Final speech outcomes were similar for CP and CLP patients. Intelligibility was normal in 10 (37%) CP and nine (53%) CLP patients. Mild consistent hypernasality was present in five (18.5%) CP and four (23.5%) CLP patients. No patients had moderate or severe hypernasality or nasal emission. Mild consistent hyponasality was present in five (18.5%) CP and five (29%) CLP patients. Moderate consistent hyponasality was present in one (4%) CP patient. Dysphonia was present in eight (30%) CP and seven (41%) CLP patients. Cleft-type characteristics were noted in 11 (41%) CP and nine (53%) CLP patients. No CLP patients but 10 (37%) CP patients had required a pharyngoplasty (P=0.004, Fisher's exact test). Possible reasons for this (age, cleft type, surgeon and surgery) are discussed.

Child↗

The posteromedial arm flap for posterior elbow defects.

A sensate, fasciocutaneous flap for cover of posterior elbow defects is described. The flap is innervated by the lower lateral cutaneous nerve of the arm. The flap is simple to raise and can be rotated and advanced over the posterior elbow region with direct closure of the proximal donor site. A case is presented.

Elbow↗

Malignant melanoma excision margins: plastic surgery audit in Britain and Ireland, 1991, and a review.

In 1991, 146 consultant plastic surgeons in Britain and Ireland were sent a short questionnaire about their policies for excision margins for primary cutaneous malignant melanoma. 106/146 (73%) replied. 39/106 (37%) considered narrow margin (2-3 mm) excision biopsies adequate in certain cases. The minimum tumour thickness for a margin of more than 1 cm was 1 mm or more for 67/106 (63%) on the leg and for 57/106 (54%) on the back. The maximum margin was specified as 4 cm or more on the leg by 37/106 (35%) and on the back by 42/106 (40%). Other sub-groups of results were analysed. A review of the literature is presented.

Attitude of Health Personnel↗

Intracellular actin as a marker for myofibroblasts in vitro.

BACKGROUND: Myofibroblasts are found in a wide variety of normal tissues and pathological conditions. It is suggested that myofibroblasts are derived from normal fibroblasts and share with smooth muscle cells the expression of actin microfilament bundles. The aim of this study was to establish if the myofibroblast phenotype from tissue expander capsules and Dupuytren's nodules could be distinguished from normal dermal fibroblasts by quantitation of intracellular actin and the ratio of polymerized (filamentous) actin to nonpolymerized (globular) actin. EXPERIMENTAL DESIGN: Cell lines were established from six patients from each group. In addition to quantitation of intracellular actin, the cells were characterized by criteria of light microscopy, ultrastructure, actin immunofluorescence, and growth rates. RESULTS: Dermal fibroblasts were the smallest and the most spindle-shaped but grew rapidly and had few actin microfilament bundles. By contrast, myofibroblasts from expander capsules were larger and more stellate, proliferated slowly, and had the most prominent microfilament arrays. Cells from Dupuytren's nodules were intermediate in phenotype. Substantial and significant differences in intracellular actin contents were found, ranging from 0.69 +/- 0.05 micrograms/10(4) cells in fibroblasts and 0.77 +/- 0.15 micrograms/10(4) cells for Dupuytren's nodule cells to 1.46 +/- 0.44 micrograms/10(4) cells in expander capsule myofibroblasts (p < 0.05). Similar findings were found with respect to ratios of fibroblast to globular actins, being 0.22 for fibroblasts and 0.38 for Dupuytren's nodule cells compared with 0.70 for expander capsule myofibroblasts (p < 0.01). CONCLUSIONS: Measurement of intracellular actin contents and fibroblast:globular actin ratios offers a rapid, sensitive, and reliable technique for establishment of the myofibroblast phenotype and has considerable advantages over traditional ultrastructural approaches for the study of myofibroblast differentiation/regression and in vitro responses to experimental manipulation.

Actins↗

Non-suture external cuff techniques for microvascular anastomosis.

Microvascular anastomosis can be achieved by eversion of the upstream vessel end over an external cuff and insertion of this into the downstream vessel. This technique, first described in 1900, was initially tested in 13 rat femoral vein anastomoses using small polythene cuffs. Two anastomoses failed and 11 were patent at 7 days. After control studies, in 16 rat epigastric flaps the femoral vein in the vascular pedicle was divided and anastomosed using an external cuff. Thirteen flaps survived. The principles underlying this method appear sound, and form the basis for microvascular anastomotic devices currently being developed.

Anastomosis, Surgical↗

Complications of radial forearm flap donor sites.

The complications of radial forearm flap donor sites in 15 patients from two centres have been reviewed. The complications included skin graft failure, swelling of the hand, stiffness of joints, reduced strength and sensation, cold-induced symptoms and fractures of the radius. Methods to reduce the incidence of such complications are discussed.

Adult↗

Reconstructive surgery in the treatment of intraoral cancer.

Patients with intraoral cancer present to various specialties. A series of 63 patients shows the importance of modern reconstructive surgery for patients treated by tumor excision. The reasons why a variety of techniques must be available to the patient are discussed. The advantages and disadvantages of some of these methods of reconstruction are reviewed.

Carcinoma, Squamous Cell↗