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Biomedical subjects

R B Noone

Publications and source records attributed to R B Noone.

16 recordsLinked to original sources
PubMed1992

The mutagenicity of electrocautery smoke.

Careful analysis of electrocautery smoke produced during breast surgery has found organic compounds that are unidentifiable with current analytical techniques. The purpose of this study was to determine the potential mutagenicity of the smoke produced by the electrocautery knife during reduction mammaplasty. Multiple air samples were collected in the operating room during two reduction mammaplasty procedures. Airborne smoke particles were tested for mutagenic potential in both tester strains of Salmonella typhimurium (TA98 and TA100) using the standard Salmonella microsomal test (Ames test). All testing was performed by the Hazard Evaluations and Technical Assistance Branch of the National Institute of Occupational Safety and Health. The smoke produced with the electrocautery knife during reduction mammaplasty was found to be mutagenic to the TA98 strain. The Ames test, an established technique for evaluating the mutagenicity of a substance, was convincingly positive for the smoke collected during the breast surgery. Whether the smoke represents a serious health risk to operating room personnel is not known. Development of techniques to limit electrocautery smoke exposure in the operating room appears to be needed, and surgeons should attempt to minimize their exposure.

Adolescent↗
PubMed1989

Salvage of jeopardized total-knee prosthesis: the role of the gastrocnemius muscle flap.

Total-knee arthroplasty has provided many patients with excellent long-term functional results. However, exposure of a total-knee replacement usually eventuates in failure. The relatively superficial location of the prosthesis, the need for early active motion, previous surgical incisions, and a variety of systemic factors may militate against early wound healing. Restoration of well-vascularized soft-tissue cover can salvage an otherwise disastrous situation. The authors recommend early operative intervention upon observation of wound breakdown, devitalized skin edges, or significant subcutaneous infection leading to necrotic overlying skin. The operative procedure found to salvage the majority of prostheses consists of adequate debridement, antibiotic irrigation (of the joint, if exposed), and coverage with a well-vascularized muscle flap, preferably the medial gastrocnemius muscle. The operative technique and ultimate long-term outcome are reviewed based on experience with 10 consecutive patients presenting with a jeopardized knee prosthesis. Follow-up ranged from 1 to 6 years. Representative case histories are presented.

Adult↗
PubMed1987

Primary Kaposi's sarcoma of an intraparotid lymph node with AIDS.

A case of Kaposi's sarcoma of an intraparotid lymph node in a patient with previously undiagnosed AIDS is presented. In patients at risk for AIDS who present with undiagnosed head and neck tumors, the diagnosis of epidemic Kaposi's sarcoma should be considered. Although transmission of AIDS to health care workers is exceedingly rare, proper precautions should be exercised when working with these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The psychological contribution of nipple addition in breast reconstruction.

Two groups of consecutive patients from two different plastic surgical practice populations were evaluated to determine psychosocial differences between those who underwent nipple-areola reconstruction in addition to breast reconstruction (N = 33) versus those who did not undergo nipple-areola reconstruction in addition to breast reconstruction (N = 26). Psychological assessment consisted of a standardized symptom inventory (Brief Symptom Inventory) and a specially designed self-report questionnaire investigating reactions unique to surgeries for breast cancer and breast reconstruction. Both groups were equivalent sociodemographically, with the exception of age, where the nipple-added group was significantly younger (P = 0.035) than the nipple-not-added group. The nipple-added group reported significantly greater satisfaction with breast reconstruction with regard to overall satisfaction (P = 0.004), satisfaction with size (P = 0.02), satisfaction with softness (P = 0.0004), sexual sensitivity (P = 0.006), and satisfaction with nude appearance (P = 0.02). Of the nine scales of clinical symptomatology on the Brief Symptom Inventory, the nipple-added group showed more increased symptoms on seven of the nine. The nipple-added group was significantly higher on two of these scales, namely, paranoid ideation (P = 0.009) and anxiety (P = 0.03).

Adult↗
PubMed1985

An objective analysis of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast.

In January 1977, the authors developed a protocol to test the advisability and feasibility of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast. Initial concerns included the morbidity of the procedure, the potential for compromise of cure and of adjuvant cancer therapy, and the aesthetic acceptability of immediate reconstruction both to the patient and to the surgeon. All patients were seen preoperatively by both the oncologic surgeon (T.G.F.) and the plastic and reconstructive surgeon, (R.B.N.), and underwent modified radical mastectomy and simultaneous reconstruction. The initial protocol included only those patients with tumors 1 cm or smaller, but over the last 25 cases the protocol has been expanded to include any patient presenting with clinical Stage I carcinoma of the breast. To date, 70 such patients (ages 27-63 years) have undergone immediate simultaneous reconstruction as part of their treatment. Twenty-five patients had evidence of microscopic nodal disease (35.7%). All patients were offered adjuvant therapy, and in no case was therapy delayed beyond 4 weeks postoperatively. Three patients developed complications resulting in loss of implant (4.3%). All patients have been followed at regular intervals, and no patient has been lost to follow-up. In only one patient was there a local recurrence without distant disease. Survival curves are consistent with the stage of the disease. The surgical techniques utilized and the methods of patient selection are discussed. The authors conclude that this is a desirable and viable option in selected patients with primary breast cancer, and that immediate simultaneous reconstruction can be done with an acceptable morbidity and without compromise of cancer therapy.

Adult↗
PubMed1985

A 6-year experience with immediate reconstruction after mastectomy for cancer.

A 6-year retrospective review is presented of 185 patients who underwent immediate reconstruction of the breast at the same operation as mastectomy for carcinoma. The patients were treated at two institutions under similar protocols of patient selection, surgical technique, and postoperative care. A detailed evaluation is presented from both the oncologic and surgical points of view. The data support the conclusion that immediate reconstruction of the breast does not alter survival or cancer recurrence rates and does not interfere with the treatment of primary or secondary disease. A low incidence of significant surgical complications is also detailed. Combined with previous reports answering psychological concerns about this mode and timing of reconstruction, this review offers significant reassurance about the overall safety of immediate reconstruction. The authors therefore recommend immediate reconstruction of the breast as a safe treatment option for the woman facing mastectomy.

Adult↗
PubMed1985

Psychosocial correlates of immediate versus delayed reconstruction of the breast.

Two groups of consecutive patients from two different plastic surgical practice populations were evaluated to determine psychosocial differences between those who underwent immediate (n = 25) versus delayed (n = 38) breast reconstruction. Psychological assessment consisted of a standardized symptom inventory (BSI) and a specially designed self-report questionnaire investigating reactions unique to mastectomy and reconstruction. Both groups were extremely equivalent with regard to sociodemographic data, with the typical subject being a well-educated and employed Caucasian wife. Verbal reports of physical complaints revealed no significant differences between the two groups except for difficulty with arm movement, which was statistically higher for the immediate group (p = 0.006.). This difference most likely was due to the axillary dissection being performed simultaneously at the time of reconstruction. The relationship between timing of reconstruction and self-reported distress over the mastectomy experience revealed that only 25 percent of the women who underwent immediate repair reported "high distress" in recalling their mastectomy surgery compared with 60 percent of the delayed reconstruction group (p = 0.02). In reference to the two scales measuring psychological symptoms, a general trend was present, with the delayed group scoring higher (although not statistically significantly) on 9 of our 12 scales. Ninety-six percent of the immediate group and 89 percent of the delayed group reported satisfaction with results.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast↗
PubMed1978

The case for the inferiorly based posterior pharyngeal flap.

The superiorly based and inferiorly based posterior pharyngeal flaps are compared. Reasons for choosing one or the other in specific cases are given. The complications with each are enumerated. The results obtained in speech comparing the two flaps in two retrospective series and one prospective series of cases failed to show a significant difference between them. Therefore, with little difference in the results and some good reasons for preferring one or the other under certain conditions, it would seem logical to select the one best suited for the particular problem.

Age Factors↗