Biomedical subjects
B Brent
Publications and source records attributed to B Brent.
A perceived cluster of amyotrophic lateral sclerosis cases in a Massachusetts community.
We investigated a report of a perceived cluster of amyotrophic lateral sclerosis (ALS) in Middleborough, Mass. Although an increase in ALS incidence was observed [2.51 deaths/100,000 person-years (p-y)], relative to the statewide rate over the years 1969-1985 (1.26/100,000 p-y), it was not statistically significant at the 95% confidence level. Problems in evaluating possible neurological disease clusters and their association with environmental exposures are presented.
Auricular repair with autogenous rib cartilage grafts: two decades of experience with 600 cases.
The purpose of this paper is twofold: to present a sound approach to auricular construction using methods that have evolved through two decades of my personal experience with 600 cases and to discuss pertinent information I have gleaned from a questionnaire sent to my operated patients. This series comprises 546 completed ears in 500 microtia patients (46 bilateral) and 75 completed ears in acquired deformities. Follow-up ranges from 1 to 17 years. Major complications such as infection, hematoma, or skin loss with cartilage exposure occurred in only 1.6 percent of cases and were limited to the perioperative period of 12 days. None have occurred in the last 9 years (481 frameworks). This paper describes the evolution and rationale for my current management of total ear repair and covers preoperative planning, how to fabricate the rib cartilage framework, how to modify the framework for specific deformities, and how to cover the framework, i.e., how to assess and use local skin and vestiges or when to supplement the coverage by recruiting fascial flaps or using tissue expansion. When considering fascial flaps, patient selection was found to be particularly important because of long-term effects on the donor scalp; expansion was found to be most useful intraoperatively. This paper also covers how to manage the hairline, how to stage the surgery, when to combine procedures, and how to manage bilateral microtia in a team approach. The survey revealed that autogenous cartilage frameworks grow, are durable, retain their detail over the years, and withstand trauma well. More than 40 severe traumas occurred in surgically constructed ears, and all healed without incident. Ears constructed in young patients generally grew to keep pace with the opposite normal side; 41.6 percent actually overgrew by several millimeters. Emotional and psychological benefits were universal, and patient satisfaction was high. Among patients who were classified as "severely affected" by the original deformity, 100 percent were pleased with the result. When considered "moderately disturbed" by the microtic defect and operated on by age 14, 95.5 percent of patients were satisfied with the surgical repair; 83.3 percent of adolescents between the ages of 15 and 20 who did not consider themselves "severely affected" by the deformity were pleased with the outcome, and the rest were "undecided."
Short-duration, high-dose urokinase infusion for recanalization of occluded saphenous aortocoronary bypass grafts.
Thrombolytic recanalization of arterial bypass grafts has been pursued aggressively in the peripheral circulation but not in the coronary circulation. In an attempt to apply peripheral transcatheter thrombolytic techniques to the coronary circulation, nine patients with 10 occluded saphenous aortocoronary bypass grafts underwent recanalization procedures using a short-duration, high-dose urokinase infusion. Urokinase was infused at the occluded graft orifice at a rate of 600 units/min. The average infusion time was 1 hr, 26 min. The average urokinase dose was 435,000 units. Graft recanalization was achieved in eight (80%) of 10 grafts, although only six (60%) of 10 grafts were widely patent at the end of the procedure. All successfully recanalized grafts required balloon angioplasty of underlying stenoses. No complications, specifically myocardial infarction or cerebrovascular accident, were encountered. We have shown that occluded aortocoronary bypass grafts can be recanalized successfully by using a short-duration, high-dose urokinase infusion. It appears that, with attention given to angiographic techniques that minimize clot manipulation, recanalization can be accomplished safely in a majority of cases.
Experience with the temporoparietal fascial free flap.
The temporoparietal fascia is an ideal tissue source for free transfer to distant sites where ultrathin coverage is either desirable or mandatory. The fascia's dependable vascular anatomy facilitates the technical aspects of microvascular transfer by means of its large vessels, ample pedicle, and ability to be grafted on either side. Furthermore, this highly vascular tissue is available in surprisingly large quantities, and its donor scar is hidden in the hair. The authors have found this flap useful (1) in covering exposed bone and tendon without adding unwanted bulk, (2) in providing thin flap coverage or lining in major facial reconstruction, (3) in covering vital structures such as exposed nerves and vessels, (4) in providing neovascularity both as a recipient graft bed and for control of chronic infection, and (5) in reestablishing gliding-tendon mechanisms. The authors have successfully employed this free flap in 15 cases which involved deformities of the ankle, foot, Achilles tendon, forearm, hand, nose, and contralateral ear and scalp. Seven cases are utilized to illustrate the broad application of this unique and versatile free flap.
Free perichondrial graft from the ear to the knee in rabbits.
Perichondrial grafts used in arthroplasties have been placed routinely with the cartilage-producing surface facing the joint space. Our study evaluates whether the orientation of the cartilage-producing surface of the perichondrial graft toward or away from the eburnated bone had any effect on the graft pattern 8 weeks after surgery. Fourteen rabbits were studied. The cartilage of both lower limb patellae was removed in all rabbits. The eburnated surfaces of 12 rabbits received perichondrial grafts from the ear, cartilage-producing side facing the joint space in one limb and cartilage-producing surface facing the bone in the other. Two rabbits that received no perichondrial grafts were also studied. After 8 weeks, the animals were killed and the patellar surfaces evaluated by gross and histologic studies. We observed that graft orientation made no difference in the histologic appearance or the thickness of the neocartilage formed.
Secondary ear reconstruction with cartilage grafts covered by axial, random, and free flaps of temporoparietal fascia.
Secondary ear reconstructions due to either previous surgical failures or severe traumatic injuries present a significant reconstructive challenge. In this paper we introduce an aggressive reconstructive approach in which radical scar excision is followed by immediate coverage of a newly sculpted cartilage framework with a temporoparietal fascial flap and skin graft. This approach evolved through experience with 40 patients who required secondary reconstructions due to either previous surgeries or trauma.
A personal approach to total auricular construction: case study.
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The correction of mi-rotia with autogenous cartilage grafts: I. The classic deformity.?
Microtia encompasses a variety of deformities whose correction presents a considerable technical challenge. In this paper, practical techniques are presented that facilitate the management of the classic form of microtia. This approach was formulated through experience with 76 patients.
The correction of microtia with autogenous cartilage grafts: II. Atypical and complex deformities.
Microtia encompasses a diverse variety of derformities whose correction must be considered individually. In part I, the classic form of microtia is described. In this article, an overview of complex microtic problems is presented and various techniques to facilitate their management are proposed.
Replantation of amputated distal phalangeal parts of fingers without vascular anastomoses, using subcutaneous pockets.
Subcutaneous "pocketing" is proposed as a simple and convenient method to nourish a denuded, replanted end of a finger, when the amputation is between the lunule and the DIP joint. The investigation of a laboratory model is presented, and our initial clinical experience is reported.
Nipple-areola reconstruction following mastectomy: an alternative to the use of labial and contralateral nipple-areolar tissues.
The techniques described herein were developed to recreate a nipple-areolar complex that avoids the inherent disadvantages of labial and "nipple-sharing" techniques. We have presented a practical, reliable, one-stage method that utilizes other tissues, and has evolved through experience with 14 cases.
The versatile cartilage autograft: current trends in clinical transplantation.
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The role of pressure therapy in management of earlobe keloids: preliminary report of a controlled study.
Prevention of postexcisional recurrence of the common earlobe keloid has long been an enigma to the surgeon. The increased realization that pressure aids in diminishing hypertrophic burn scars has stimulated us to develop an effective pressure device to control the collagen overgrowth frequently occurring after initial keloid excision. Our device is a decorative spring-pressure earring that is applied to the earlobe 2 weeks after excision of the keloid. The patient is instructed to wear the earring for 4 to 6 months. An effective evaluation of this device was carried out through its bilateral use in some patients. The earring was used initially on only 1 ear; when early recurrence was detected in the control ear, application of the device diminished and prevented keloid reformation. This innovation promises to be an important adjunct in the prevention of postexcisional recurrence of earlobe keloids, and the preliminary results are reported with a 12 to 15 month follow-up. Constant light pressure is discussed as an effective means of preventing postexcisional recurrence of these lesions.
Perichondro-cutaneous graft.
A perichondro-cutaneous graft uniquely provides skin cover with the potential of generating its own cartilaginous support. An initial laboratory investigation is reported, and various applications of this graft to reconstructive facial surgery are proposed. Several clinical cases are presented.
Reconstruction of traumatic ear deformities.
Post-traumatic auricular deformity is a unique and varied problem that taxes the ingenuity of the plastic surgeon. Case individualization is repeatedly demanded and a systematic assessment of the residual tissue is requisite to planning an appropriate reconstruction. A basic guideline is presented to emphasize fundamental principles of plastic surgery and tissue transplantation as they are applied to this challenging area of our specialty.
The acquired auricular deformity. A systematic approach to its analysis and reconstruction.
Acquired ear deformities present unique and varied problems which tax the ingenuity of the plastic surgeon. Case individualization is necessary, and a systematic assessment of the residual tissues is a requisite when planning an appropriate reconstruction. Cases performed by one surgeon have been used to demonstrate the basic principles of these repairs. A systematic approach to the reconstruction of these acquired deformities is presented.
Nipple-areola reconstruction with auricular tissues.
Various methods of reconstructing the nipple-areolar complex with auricular tissues are presented. A basic one-stage reconstructive technique is described which seems suitable for the use of various tissues. An alternative method of correcting the inverted nipple is reported.