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Biomedical subjects

R H Milner

Publications and source records attributed to R H Milner.

At least 19 recordsLinked to original sources
PubMed2006

Surgical treatment of chronic parotid sialadenitis.

OBJECTIVE: To review the results of surgical management of chronic parotid sialadenitis refractory to medical therapy, with particular respect to long-term symptom resolution and development of post-operative complications. METHODS: A retrospective review of parotidectomies performed for chronic intractable parotid sialadenitis. Information was collected about presentation, pre-operative investigations, surgical treatment, post-operative complications and outcome. RESULTS: 36 parotidectomies were performed for chronic sialadenitis between 1991 and 2002. Age at presentation was 56+/-9.6 years, with median symptom duration of 2.3 years. For patients with non-specific presentations, magnetic resonance imaging (MRI) was the most useful pre-operative investigation. Superficial parotidectomy with duct preservation was the main treatment with a 94 per cent success rate, and near-total parotidectomy was reserved for patients with extensive deep-lobe involvement. Duct ligation significantly increased the risk of transient facial palsy. There was a 56 per cent and 22 per cent incidence of temporary facial paresis and Frey's syndrome, respectively. CONCLUSIONS: Controversies exist regarding the optimal pre-operative investigation and surgical treatment of chronic parotid sialadenitis. We advocate magnetic resonance image (MRI) scanning for patients with non-specific symptoms of sialadenitis, and sialography in the presence of reasonable clinical suspicion. We propose superficial parotidectomy without parotid duct ligation as the standard of care, with near-total parotidectomy reserved for extensive deep-lobe disease.

Adolescent↗
PubMed2003

Dupuytren'S disease affecting the thumb and first web of the hand.

The clinical distribution of the Dupuytren's disease cords in the thumb and first web was examined in 100 consecutive patients with Dupuytren's disease. The precise anatomical relations of the cords were then studied in 25 patients undergoing Dupuytren's surgery for thumb and first web space disease. Thumb and first web space involvement was found in 28% of hands affected by Dupuytren's disease, and was the third most common site after the ring and little fingers. Operative findings showed that two major cords could be distinguished. One lying in the first web space and passing towards the insertion of the first dorsal interosseous muscle on the radial side of the index finger and the other lying on the radial aspect of the thumb.

Dupuytren Contracture↗
PubMed2003

A comparison of ex vivo and in vitro Sutter metacarpophalangeal prostheses.

Forty-one Sutter metacarpophalangeal prostheses were implanted into 11 hands of nine patients. Twelve of these prostheses were revised from three patients after a mean period of 42 months. Of the 12 prostheses, 11 showed fracture at the junction of the distal stem and the central hinge region. Two Sutter metacarpophalangeal prostheses were tested on a single station finger simulator and both failed due to fracture at the junction of the hinge and the distal stem.

Arthritis, Rheumatoid↗
PubMed2003

Bimodal distribution of the blood supply to lower abdominal fat: histological study of the microcirculation of the lower abdominal wall.

Fat necrosis is a common postoperative complication in transverse rectus abdominis muscle flap breast reconstruction. A histological quantification of the blood supply to the lower abdominal fat was undertaken to define this problem further. One hundred eighty sections, 1.5 cm(2) in size, were studied from one half of the lower abdomen in 10 fresh cadavers. These represent three different depths of fat (superficial, middle, deep) and six different anatomic areas (upper, middle, and lower sectors of the medial and lateral parts of the hemiabdomen). The average diameter, number of blood vessels, and the total vascular area were measured in each section. The average diameter of the blood vessels was greater in the superficial compared with the mid fat layer (p = 0.02). The total vascular area was greater in the deep compared with the mid fat layer (p = 0.01) and the superficial fat layer (p = 0.05). The number of blood vessels was also significantly higher in the deep fat layer compared with the mid fat layer (p = 0.001) and the superficial fat layer (p = 0.01). The lower medial area of the lower anterior abdominal wall contained the largest number and average diameter of blood vessels whereas the mid lateral area contained the smallest number and average diameter; however, this did not reach significance (p = 0.1 and 0.2). The results of this study are in keeping with the bimodal vascular supply to the subcutaneous fat of the anterior abdominal wall. The deep and the superficial fat layers are supplied more richly with vessels with a larger diameter whereas the intermediate fat layer is supplied from the terminal branches of these vessels.

Abdominal Wall↗
PubMed2002

Supercharged pedicled TRAM flap in breast reconstruction: is it a worthwhile procedure.

A clinical study of the incidence of vascular complications in free and supercharged pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps was undertaken. The complications associated with each of these two TRAM flaps were assessed. The incidence of vascular complications in the supercharged pedicle was found to be twice that associated with the free TRAM flap (36% vs. 18%); however, these results did not reach significance ( = 0.2). Fat necrosis was the most common complication in each group, with the overall rate being 17%. The incidence in the supercharged TRAM flap (29%) was more than twice that in the free TRAM flap (13%; = 0.2). Partial flap loss was also greater in the charged flap than in the free flap (14% vs. 3%, = 0.1). The results, however, did not reach significance, and this may be related to the relatively small sample size (52 patients). Vein grafts were used more often in the supercharged pedicled TRAM flap ( = 0.02). Obesity was also associated more frequently with the supercharged pedicled TRAM flaps ( = 0.07). Other risk factors were nearly equally distributed between either type of the flap. The results of the study support the continued use of the free TRAM flap. There appears to be no additional advantage in charging the pedicled TRAM with a microvascular anastomosis because the results were found to be inferior to those of the free TRAM flap. Other clinical factors, however, may dictate the type of flap used. A larger series is required to assess the importance of each of the risk factors affecting flap survival.

Adult↗
PubMed2001

Carpal tunnel syndrome: the correlation between outcome, symptoms and nerve conduction study findings.

A retrospective study was performed on 62 patients who had undergone carpal tunnel decompression surgery. Each patient was assessed in clinic, their case notes were reviewed and their electrophysiological results were analysed and graded according to severity. The median preoperative duration of symptoms was 2 years. No relationship was found between the nature or duration of pre-operative symptoms and the severity of the electrophysiological impairment. Furthermore, no relationship could be identified between pre-operative nerve conduction impairment and either successful outcome of surgery (defined as complete symptom relief) or time to resolution of symptoms after surgery.

Carpal Tunnel Syndrome↗
PubMed1998

A prospective randomized comparison of Sutter and Swanson silastic spacers.

This study compares two currently available prostheses for the reconstruction of rheumatoid joints. A single operator performed 72 resection arthroplasties with Swanson or Sutter prostheses being randomly allocated. Assessment of each patient was carried out preoperatively, and at 6 months and 12 months postoperatively by a single investigator. In the Swanson group an improvement of the flexion arc was seen, from 29 degrees to 44 degrees at 6 months but this reduced to 36 degrees at 12 months. In the Sutter group there was no significant difference between flexion arcs pre- and postoperatively. Grip strength improved in the Swanson group, but not in the Sutter group. Extensor lag was improved in both groups. Patient satisfaction measured by linear analogue scales for pain, function and deformity was high in both groups.

Aged↗
PubMed1998

A study of the dimensions and taper angles of the medullary canals of the proximal and middle phalanges.

The morphology and dimensions of the medullary canals of the proximal and middle phalanges have been studied with particular interest shown to the angle of taper of these canals. Measurements of 50 cadaveric fingers were taken from computer aided tomographic images using AutoCAD software. Tangents were fitted to the inner cortices in two orthogonal planes and the angles between them were measured. The angles of canal taper in the proximal phalanx were remarkably similar for each digit. This was also true for the middle phalanx of the index, middle and ring fingers but the taper of the middle phalanx of the little finger was found to be different.

Aged↗
PubMed1998

Intraneural lipofibroma of the median nerve.

Intraneural lipofibroma of the median nerve is rare. We present three cases of this condition and discuss the surgical management. Open biopsy and carpal tunnel release are usually required.

Adolescent↗
PubMed1997

An evaluation of the Würzburg titanium miniplate osteosynthesis system for mandibular fixation.

We present an 8-year experience with the Würzburg noncompression titanium miniplate system for the rigid fixation of the mandible during elective head and neck cancer surgery in a consecutive series of 100 patients. One half of the miniplates were used to fix mandibulotomies undertaken for surgical access. The remaining half were in patients undergoing reconstruction of segmental mandibular defects, the vast majority (92%) with vascularised bone grafts. One to four variously shaped miniplates were used per patient (mean = 1.5), plate size ranging from 4 to 40 holes. Fifteen patients (15%) developed complications which included 3 mandibular osteoradionecrosis, 8 broken, 5 infected, and 4 exposed plates. Three of the eight fractured plates were associated with nonunion. In this study, the main advantages of titanium miniplate fixation, namely case of application, decreased fixation time and malleability, were accompanied by a level of morbidity which, while comparing well with alternatives, may necessitate a reappraisal of this technique of fixation.

Adolescent↗
PubMed1996

Human papilloma virus proliferation in a healing burn.

A 4-year-old boy sustained a superficial burn to his finger at the site of a viral papilloma. The burn was treated conservatively. During re-epithelialization the human papilloma virus (HPV) incorporated its genome in the regenerating cells, leading to a verruca as large as the original burn. Diagnosis was reinforced by a history from the patient's mother. Complete resolution of this complication was achieved with topical therapy.

Antiviral Agents↗
PubMed1994

Long term follow-up of dermofasciectomy for Dupuytren's contracture.

During the 4-year period 1980-1983, we carried out 338 operations for Dupuytren's disease of the hand. Of these 46 (13.6%) had a dermofasciectomy and skin graft for recurrent disease. In this sub-group, 34 patients (10.1%) were operated on by the same senior surgeon (H.G.B.). Only these cases were included in this study. Average follow-up was 100 months (range 80-120 months). It was found that graft durability was good, there was no clinical evidence of recurrence beneath grafts, contracture did not exceed 15 degrees at any joint and two point discrimination in the graft was equal to, or better than, 12 mm in the palm and 8 mm in the digit.

Adult↗
PubMed1992

The recovery of peripheral nerves following tissue expansion.

A rat sciatic nerve model has been used to study the response of nerves to tissue expansion and their recovery at intervals up to 100 days using electrophysiology and histological methods. Tissue expansion has been shown to increase nerve length by 32% of which half remained at 100 days. Following tissue expansion the mean conduction velocity of the sciatic nerve was reduced to 30.0 +/- 1.35 m/s which represented 60.3% of control values, by 100 days the conduction velocity had almost returned to normal. Histological examination showed the cause of the reduction in function to be due to segmental demyelination without axonal degeneration, these changes returned towards normal during the recovery period but were not completely reversed by 100 days.

Animals↗
PubMed1989

The effect of tissue expansion on peripheral nerves.

The effect of tissue expansion on peripheral nerves was studied in 214 rats. Slow expansion (over 15 days) is better tolerated than rapid expansion (over 3 days). The resulting increase in length of the nerve is proportional to the degree of expansion. All the nerves which underwent expansion showed a decrease in conduction velocity and this reduction was greater for nerves which were elongated by 50% or more.

Animals↗
PubMed1989

A distally based first web flap in the foot.

A flap can be raised from the dorsum of the foot based distally on the first web-space. It is supplied by branches of the dorsal and plantar metatarsal arteries and their distal communicating branches. It is reliable, does not contract and is useful in resurfacing defects in the distal foot overlying the metatarsophalangeal joints.

Contracture↗