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Biomedical subjects

C M Barone

Publications and source records attributed to C M Barone.

At least 37 records · Page 2Linked to original sources
PubMed1996

Outcome analysis of reduction mammaplasty.

In an attempt to obtain objective analysis of outcome in reduction mammaplasty patients, a retrospective study was done for women having elective bilateral reduction mammaplasty. Participants were chosen from a pool of over 200 consecutive reduction mammaplasty patients at the University of Missouri-Columbia. Of those eligible for inclusion, 72 met the criteria and were available for long-term follow-up. These patients answered a panel of questions regarding weight change, brassiere size, exercise, activity level, symptoms, and a personal appraisal of appearance. Statistical analysis was done to evaluate the change in each variable in relationship to the time of surgery, i.e., before surgery, 6 months after surgery, and at the present time. The findings revealed a significant stable reduction of breast mass. The women reported a significant reduction of symptoms that had been associated with their macromastia. They also reported a significant increase in exercise and other physical and social activities.

Activities of Daily Living↗
PubMed1996

Special considerations in pediatric cranial fixation: a technical overview.

Advances in plate fixation design have made possible traumatic and elective cranial reconstruction in pediatric patients. Plating systems must be selected properly, particularly in growing infants and children, in whom long-term computerized axial tomography (CAT) scanning and magnetic resonance imaging (MRI) may be necessary. Specific concerns include an actively growing skull with resulting dynamic bony contour changes. The results of 41 children with approximately 5 plates per case, totaling 205 implantable devices, were studied. This article addresses safety and image quality of metallic implants on CAT scan and MRI scanning, growth restriction induced by rigid plating systems, passive internal displacement of plates and screws with possible dural and cortical penetration, plate and screw isolation, and recommendations for cranial fixation in children.

Animals↗
PubMed1995

The Sunrise Technique: the correction of occipital plagiocephaly using bandeau occipital plate and radial osteotomies.

Posterior plagiocephaly secondary to lambdoid suture stenosis requires surgical release and repair to prevent progressive deformational changes associated with a suture stenosis. A surgical technique is described for release of the stenosed lambdoid suture and asterion region, followed by occipital reconstruction. This technique provides excellent cosmetic results. Using a standard biparietal incision, most of the occipital bone is removed en bloc. The asymmetric occiput is then reconstructed using an autologous bone bandeau and Marchac forehead template graft. The remaining bone is cut into longitudinal strips and placed in a centrifugal fashion around this construct. This technique creates a stable unit that provides immediate symmetry to the occipital area. The operative time and blood loss are comparable to that of similar procedures. With this technique there have been no complications or need for reoperation.

Cranial Sutures↗
PubMed1995

Intraoperative autologous blood transfusion in the surgical correction of craniosynostosis.

Transfusion of homologous blood is associated with significant and well-known risks. Reported transfusion rates for pediatric patients undergoing surgical correction of synostotic calvarial sutures vary between 20 and 500% of estimated blood volume. The objective of this study was to ascertain the risks, benefits, and effects on transfusion rates associated with the use of intraoperative autologous transfusion (IAT) in this patient population. The Haemonetics Cell Saver 4 (Haemonetics Corporation, Braintree, MA) autotransfusion system was used to salvage blood in 18 patients undergoing the release of stenosed calvarial sutures. In a prospective, nonrandomized study, these patients were compared with a control group of similar age, gender, weight, and surgical procedures. There were 10 male patients and 8 female patients; the mean age was 7.2 months, the mean weight was 8.67 kg, and the mean surgical time was 3.15 hours. The mean amount of homologous blood transfused to the control group was 189 ml, compared with 87.69 ml for the IAT group, which was a decrease of 46.3%. The mean amount of autologous blood transfused was 150 ml (range, 50-250 ml). Thirty-three percent of the patients in the IAT group did not require homologous blood transfusion. No complications were observed with the use of the Cell Saver in the IAT group. The use of the Cell Saver was associated with a significant decrease in the amount and rate of homologous blood transfusions. Its use appears to be safe in pediatric patients undergoing craniosynostotic surgery.

Blood Loss, Surgical↗
PubMed1994

Effects of rigid fixation device composition on three-dimensional computed axial tomography imaging: direct measurements on a pig model.

OBJECTIVE: To compare the amount of scatter produced by titanium plates versus Vitallium (Howmedica, Rutherford, NJ) plates. Software was also evaluated to determine its effectiveness in removing the scatter and clarifying the underlying anatomy. MATERIALS AND METHODS: Miniplating and microplating systems composed of Vitallium or titanium were placed on the nasal and frontal bones of three adult pig heads. A computerized axial tomography (CAT) scan was then performed and a three-dimensional CAT scan was reconstructed using MediCad software (MediCad Inc, Cedar Knolls, NJ). The amount of scatter for each plating system was quantitated using the MediCad software measuring tool. The scatter was removed and the three-dimensional CAT scan was reconstructed to assess the clarification of the underlying anatomy. RESULTS: No scatter was found with either the miniplating or the microplating system composed of titanium. The Vitallium plates did show significant amount of scatter with the mini, micro, and micromesh system. Removal of the scatter resulted in slight improvement in the anatomic detail. CONCLUSION: Titanium plating systems do not cause any radiation scatter. The MediCad software system allows removal of the scatter found with the Vitallium plates, which helps clarify the underlying anatomy.

Animals↗
PubMed1994

Monobloc correction of external nasal deviations.

Nine patients (7 men, 2 women) with external nasal deviation underwent corrective procedures using a monobloc nasal osteotomy technique. The deformities ranged from mild to severe. Eight patients had post-traumatic deviations, whereas 1 had a unilateral cleft nasal deformity. For this monobloc technique, osteotomies were performed at unequal levels to correct the height difference, no periosteal undermining was performed, and septal dissection was undertaken only after monobloc repositioning. There was no need for grafts or microplate fixation. Minimum follow-up was 8 months. All patients had improvement in their external deviation, 1 patient was mildly undercorrected, and only 1 patient (cleft nasal) required a radical submucosal resection.

Adolescent↗
PubMed1994

Hematomas requiring surgical evacuation following face lift surgery.

This study evaluates hematomas requiring surgical evacuation following a face lift. Twenty-three hematomas occurred with 1236 consecutive face lifts (1.86 percent). All hematomas occurred within 48 hours. Fifty-seven percent were identified at less than 15 hours, 26 percent from 15 to 24 hours, and 17 percent from 24 to 48 hours. The incidence of hematomas for surgeons who performed more than 50 face lifts in this study varied from zero to 3.83 percent. This difference in incidence was statistically significant. A multivariant analysis of predetermined variables was done. Age, preoperative tests, medical history, gender, perioperative medications, type of anesthesia, number and combination of procedures, and treatment of the SMAS did not independently affect the incidence of hematomas. Preoperative and postoperative blood pressure did not affect the incidence. The incidence of hematomas with general anesthesia in this study was 7 of 630 (1.11 percent). In a similar 1973 study at this institution, the incidence with general anesthesia was 3.26 percent. This improvement was attributed to a change in anesthetic technique. Intraoperative hypotension was avoided in the current series. The incidence of hematoma in the local anesthesia group was 3.72 percent, and in the monitored intravenous sedation group it was 0.87 percent. Meticulous hemostasis, done with the patient's blood pressure in a normotensive state, appeared to be of primary importance.

Face↗
PubMed1994

Achondroplasia: pre- and postsurgical considerations for midface advancement.

Achondroplasia, the most common type of dwarfism, involves several physical characteristics that can cause pre- and intraoperative respiratory problems. The characteristics include rib-cage deformities, midface hypoplasia, choanal stenosis, muscular hypotonia, foramen magnum compression, and cervical abnormalities. Specific pre- and postoperative strategies for dealing with achondroplastic dwarfs are discussed.

Achondroplasia↗
PubMed1994

Asterion region synostosis.

Posterior plagiocephaly historically has been associated with synostosis of the lambdoid suture. The incidence, diagnosis, and modes of treatment for stenosis of the lambdoid suture remain controversial. Commonly, the lambdoid suture is found to be open both on radiographic examination and at the time of surgery. The study reports on nine patients who presented with unilateral posterior plagiocephaly and who were found to have open lambdoid sutures, but a stenosed region of the asterion. The area of involvement included the distal-most lambdoid suture, the parietomastoid, occipitomastoid, and proximal squamosal sutures. Positional molding or torticollis was ruled out in all patients. All the patients showed progressive involvement of the skull base, including anterior shifts of the ipsilateral ear, compensatory ipsilateral frontal bossing and malar protrusion. Stenosis of the asterion was diagnosed with three-dimensional computed tomography scans, corroborated at the time of surgery and confirmed histologically. Surgical correction involved resection of the affected asterion and reconstruction using a bandeau-technique, barrel staves of the occipital bone and bone graft transposition. This approach provided excellent esthetic results in all patients.

Cranial Sutures↗
PubMed1994

Calvarial defect reconstruction.

The history of skull trepanation is almost as old as that of humanity. For thousands of years it has been performed for the treatment of numerous medical maladies. The Andean Incas, early Asians and South Seas Islanders, are amongst the many people to perform calvarial trepanation. Hippocrates described techniques for the use of the trepan in early Greek times. With the production of a skull opening comes the challenge of developing methods for closing the defect. It is in reality, more challenging to repair the defect than to create it. Man, with his never ending ingenuity, has tried to develop many techniques. We will discuss some of them and present our method of choice for closure of skull defects.

Bone Transplantation↗
PubMed1994

Pharyngeal flap revisions: flap elevation from a scarred posterior pharynx.

Twenty-one consecutive patients who had earlier superiorly based pharyngeal flap surgery and persistent velopharyngeal insufficiency were seen between 1976 and 1991. Patients were divided into two treatment groups, depending on the results of videofluoroscopic and nasopharyngoscopic assessment. The first group consisted of 18 patients who had bilateral port insufficiency and required a complete reconstruction of a new superiorly based pharyngeal flap that was elevated from a scarred posterior pharyngeal wall. After an average follow-up of 6.2 years, 15 patients had normal resonance, 2 patients had improvement but continued hypernasality, and 1 patient was hyponasal. The second group consisted of 3 patients who had "patch" flaps to a unilateral port insufficiency. Postoperatively, all 3 of those patients had normal resonance. Indications for the decision to "redo" or patch flaps are described.

Adolescent↗
PubMed1993

Craniofacial, limb, and abdominal anomalies in a distinct syndrome: relation to the spectrum of Pfeiffer syndrome type 3.

Presented are 2 patients with abnormal craniofacial region, limbs, and abdomen, features that may be consistent with Pfeiffer syndrome, type 3. Both patients had bicoronal and bisphenoidal synostosis, extreme exophthalmic midface hypoplasia, and hydrocephalus. The limbs had a fixed flexion deformity of the elbows with broad thumbs which were radiopalmarly deviated; the toes were broad with a varus deformity and syndactyly toes 2-5. Both patients developed bowel obstruction secondary to midgut malrotation, and one of the patients had prune belly syndrome. Review of the literature disclosed an additional patient who, in retrospect, had Pfeiffer syndrome type 3 and midgut malrotation. These patients suggest that intestinal malrotation with or without prune belly syndrome may be a common component of this entity.

Abdomen↗
PubMed1993

Treatment of toxic epidermal necrolysis and Stevens-Johnson syndrome in children.

A retrospective study was carried out on eight consecutively treated children, 2 to 14 years of age, seven with toxic epidermal necrolysis and one with transitional-type Stevens-Johnson syndrome. The body surfaces affected ranged from 40% to 100%. Seven of the patients were taking a sulfonamide or anticonvulsant before the onset of their disease. Complete reepithelialization took an average of 15 days, but newly evolving lesions of the lips and oropharynx continued for approximately 4 more weeks. These lesions took an additional 2 to 4 weeks to heal. Only one of the children died.

Adolescent↗
PubMed1993

Distraction of the frontal bone outside the cranial plane: a rabbit model.

Distraction of the frontal bone outside the cranial plane using the Ilizarov principle was performed in 17 22-week-old New Zealand white rabbits. Five rabbits had frontal bone osteotomy only and were in the control group; 5 rabbits were placed in the sham control group and had frontal bone osteotomy plus application of a customized headgear appliance; and 7 rabbits were placed in the experimental group, which underwent frontal bone osteotomy application of the headgear and distraction. The frontal bone was elevated 1 mm every other day for a period of 8 weeks, and the animals were then killed. Cephalometry was performed both preoperatively and at the end of the 8-week period. Histological examination of the skulls was also performed. The experimental group showed a significantly elevated frontal bone compared to the sham control group (p < 0.05). Callous bone filled the distracted segment, which united the frontal bone with the cranial plane. Therefore, frontal bone advancement by distraction osteogenesis is possible using this rabbit model.

Animals↗
PubMed1993

Refinements of the tongue flap for closure of difficult palatal fistulas.

The posteriorly based tongue flap can be very useful to close difficult palatal fistulas, especially because the palatal sling prevents dehiscence of the tongue flap. However, special techniques may need to be employed with very large palatal fistulas or severely scarred palates. This technique has been used successfully in 5 patients. A detailed case report is presented, for which refinements of the tongue flap technique was required.

Child↗
PubMed1992

Blood-flow measurements of injured peripheral nerves by laser Doppler flowmetry.

The effects of injury on peripheral nerve blood flow were studied, using a Laserflo blood perfusion monitor. A total of 11 nerves were studied, five normal and six injured nerves in four patients. Two of the patients had lacerating brachial plexus injuries, and two other patients had compressive neuropathies of their ulnar nerves at the elbow. All of the readings were taken intraoperatively while the patients were undergoing exploration and repair under general anesthesia. Measurements of the damaged nerves were taken serially from the site of injury proximally and distally, by approximating a flexible metric ruler to the dorsal aspect of the nerve along the same axis. In the acutely lacerated injured nerves (3 to 7 days), the measurements were taken at 1, 5, 10, and 20 mm. The maximal amount of retraction in any of the nerves was 1 cm; thus, the overall architecture of the nerves was maintained. In the compressed nerves, measurements were taken at 1, 2 and 3 cm proximal and distal to the medial epicondyle. Measurement of normal undamaged nerves was performed at six different sites along the same axis of the nerve. The averaged results indicate that the normal blood flow ranged from 47 ml/100 g/min to 63 ml/100 g/min, with a mean of 56 ml/100 g/min. In the injured nerves, blood flow was most depressed at sites closest to the laceration, and increased consistently and progressively at sites distant from the injury in both directions.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗