Subcutaneous mastectomy and breast replacement: its role in the treatment of benign, premalignant, and malignant breast disease.
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Breast Diseases↗
Biomedical subjects
P K Blevins
Publications and source records attributed to P K Blevins.
Naso-ethmoid-orbital fractures.
This report reviews the experience with naso-ethmoid-orbital fractures at a major medical center. Thirty-three patients were treated between 1 October 1976 and 1 January 1979, who met our definition of naso-ethmoid-orbital fractures. The majority sustained trauma in a motor vehicle accident and 60% of the patients had associated nonfacial injuries. All patients had other facial injuries and fractures; orbital rim or floor, 94%; complex maxillary (LeForte II-III), 72%; and mandible fractures, 25%. Slightly over one half of the group of naso-ethmoid fractures were open; the remainder were closed injuries. Traumatic telecanthus was noted in 70% of the patients on initial examination. Cerebrospinal fluid rhinorrhea was evident in 40%, and frontal sinus fractures were detected in 25% of the group. Severe ocular injury with initial or subsequent loss of sight occurred in an alarming 30% of the patients. In addition, nasolacrimal duct system lacerations occurred in 20%. One patient developed a large carotid artery-cavernous sinus fistula 1 month postinjury. The severity of these injuries and the potential for deformity and dysfunction have not been properly emphasized in the past. Our experience has defined several diagnostic and therapeutic guidelines. For example, vastly improved results were obtained with an open reduction and internal fixation procedure. A multidisciplinary approach by a neurosurgeon, ophthalmologist, and plastic surgeon is mandatory.
Adolescent↗
Limitations of the cervicohumeral flap in head and neck reconstruction.
The cervicohumeral flap has proven useful in head and neck reconstruction. The limitation of the flap appears to be the length of the flap. Its major disadvantage is a lack of predictability of length of survival beyond the deltoid insertion.
Adult↗
Progress in biliary stricture repair.
Between 1967 and 1970 inclusive, 119 patients underwent 158 operations for the relief of benign bile duct stricture. During this time hepaticojejunostomy was favored for biliary reconstruction, since eighty procedures were of this type. Thirty-eight were end to end repairs and the remainder were a variety of other types. Of the cases evaluated, 58 per cent of the hepaticojejunostomies and 61 per cent of the end to end repairs produced satisfactory results. This experience is an improvement over a previously reported earlier series from this institution. Only three patientd died postoperatively, a significant reduction over an earlier mortality. Further experience with the use of the modified Y tube has been gained in forty-two cases, and it suggests that the benefits might be statistically significant in hepaticojejunostomy if the number of cases were increased. We have begun to evaluate the transhepatic circle tube which can be replaced, when obstructed, on an outpatient basis, thus allowing longer use of stents. Analysis of obstructive biliary sludge in five stents suggests that the sludge is a polymer of bile pigment that is insoluble in both aqueous and organic solutions and therfore not preventable or dissolvable by the administration of chenodeoxycholic acid.
Biliary Tract Diseases↗