The transverse cervical neurovascular free flap.
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Biomedical subjects
Publications and source records attributed to R L Morris.
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A case of a large central neurofibroma of the left posterior maxilla is presented. This lesion was treated by a left radical maxillectomy because of the extensive nature of the tumor. The surgical defect was reconstructed with a latissimus dorsi myocutaneous flap. The incidence and clinical features of intraosseous benign nerve sheath tumors are discussed.
The anatomy and technique of applying the pedicled latissimus dorsi myocutaneous flap to head and neck defects and three cases illustrating this application are presented. Additional points of interest, further experience with the flap, and some pitfalls are discussed.
Peripheral blood mononuclear cells from patients with chronic atopic dermatitis were evaluated as effectors of antibody-dependent cellular cytotoxicity (ADCC) to determine if faulty effector function might explain the susceptibility of atopics to severe cutaneous viral infections in spite of adequate specific antibody titers. Eleven atopic patients whose dermatitis was well controlled and who were not infected or on immunosuppressive therapy were studied using sensitized human and chicken erythrocyte targets at three different effector:target ratios. No significant differences in mean ADCC were seen between atopics and controls. However, the function of peripheral blood mononuclear cells from atopic patients who had a previous history of severe cutaneous viral infection was significantly depressed against sensitized chicken, but not human targets. This suggests that atopic patients who develop severe cutaneous viral infections may represent a subset of atopics with an intrinsic or variable defect in K lymphocyte--mediated ADCC which might render them susceptible to persistent, extensive viral infections.
A retrospective assessment of 50 vascularized composite tissue transfers was carried out with 48 patients. Factors responsible for improved tissue survival included (1) the evaluation and proper selection of recipient vasculature, (2) the increased dependence on the vacularized latissimus dorsi musculocutaneous flap, and (3) the frequent use, wherever possible, of an end-to-side arterial anastomisis. Specific indications for reconstruction of the lower extremity with vascularized composite tissue include (1) avulsive injuries to the distal tibia and foot, (2) the failure of conventional methods, (3) the treatment of extensive chronic osteomyelitis, (4) deficiency of both soft tissue cover and skeletal support, (5) the restoration of form and contour with minimal secondary deformity of the donor site, and (6) extensive loss of soft tissue only. Reconstruction of the lower extremity with vascularized tissue is a reliable method with acceptable patient and tissue morbidity statistics that should be considered when specific indications are present.
Xylary fluid pH and reduction potentials were measured on silver maple (Acer saccharinum L.) grown under Fe and pH stress. Although pH and reduction potential (millivolt/59.2) varied significantly in the nutrient solution, xylary pH and reduction potential remained constant. It was concluded that changes in the pH and reduction potential in the xylary fluid of silver maple are not responsible for iron chlorosis.
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Endometriosis causing acute small bowel obstruction is a clinical complex which should be considered in the differential diagnosis of intestinal obstruction. Theories as to etiology and pathogenesis are discussed. The best clue to preoperative diagnosis of the lesion is a careful history with regard to previous episodes of ileus having menstrual periodicity. The lesion itself usually causes obstruction by kinking or volvulus secondary to serosal adhesion formation, and more rarely by stenosis or intussusception. The treatment of total small bowel obstruction secondary to endometriosis is surgical, with resection of the involved bowel and end-to-end anastomosis.
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