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Biomedical subjects

D J Hauben

Publications and source records attributed to D J Hauben.

At least 55 records · Page 3Linked to original sources

The effect of allopurinol on experimental island skin flap survival under prolonged periods of arterial ischaemia.

The aim of this study was to assess the effect of allopurinol on rat groin flaps rendered ischaemic by selectively occluding the feeding femoral artery and reperfused by means of microsurgical anastomosis. For the establishment of the critical arterial ischaemia time, the femoral artery of 29 rat groin flaps isolated on the inferior epigastric pedicle was occluded for 10, 12 and 14 h. Following 12 h or more of ischaemia, 5.25% of the flaps survived, compared to 40% survival after 10 h (p = 0.04). In the second stage of the study, 34 rat groin flaps were subjected to arterial ischaemia for 12 h. Of these, 12 rats received allopurinol solution I.V. 30 min prior to reperfusion, 10 received the vehicle solution (control) and 12 underwent no treatment (control). After 7 days, survival of the groin flaps was observed in 41.7%, 0 and 8.3% of the groups, respectively (p = 0.0164). This study suggests that systemic administration of allopurinol has a beneficial effect on rat arterial ischaemic groin flaps and may prolong their critical ischaemia time.

Allopurinol↗

The otolaryngologist and the patient with velocardiofacial syndrome.

Velocardiofacial syndrome is the most common syndrome associated with clefting of the secondary palate. The endoscopically diagnosed occult submucous cleft palate is the most common palate anomaly associated with this syndrome. Patients with velocardiofacial syndrome present a special challenge to the otolaryngologist, who must be familiar with the diagnostic and therapeutic aspects of this syndrome. We report the findings in 21 patients with velocardiofacial syndrome. Only 11 (52%) had the typical manifestations, and others had only partial phenotype. Adenoidectomy must be avoided in these patients, since undiagnosed occult and overt submucous cleft palate are the most common cause of velopharyngeal insufficiency after adenoidectomy. Three patients had aberrant carotid arteries. This anomaly must be excluded by nasoscopy and computed tomographic scanning before pharyngeal flap surgery is considered in these patients. Criteria for exclusion of high-risk patients from adenoidectomy are presented and discussed.

Abnormalities, Multiple↗

Epidemiology of burns in the Tel Aviv area.

Between 1 August 1988 and 31 January 1992, 421 burn patients were admitted to the Burn Unit at Beilinson Medical Center. Name, age, sex, month of the year, cause of burn, area and degree of burn and duration of stay in hospital were recorded. Of these patients, 37 per cent were treated surgically and the remainder were treated conservatively. The male to female ratio was 2:1. Burns occurred most frequently in July and January; the peak average age was the first decade of life. The most frequent cause in children was scalding (domestic burns), and in adults open fires (work accidents). Patients treated by early tangential excision and skin grafting (204 operations on 157 patients) had a shorter stay in hospital than conservatively treated patients. In accordance with others, we suggest that early surgery of burn injuries decreases morbidity and mortality and leads to better aesthetic results and improved motor function. Secondly, burn injury can be prevented in children and the elderly by increasing safety measures at home, and in adults by enforcing strict safety measures at work.

Adolescent↗

Double-opposed Z plasty for upper eyelid entropion correction.

Recurrent cicatricial entropion of the upper eyelid creates a surgical problem. We present a 53-year-old patient with complicated postsurgical fibrotic and scarred upper eyelid entropion. Double-opposed Z-plasty incisions were used at the anterior approach. The outer Z incision included the skin and the orbicularis oculi muscle underneath, whereas the inner Z incisions included the tarsal plate and conjunctiva, in a mirror-image fashion. Two goals were achieved, i.e., release of the vertical traction vector of the conjunctiva and balance of forces between the anterior and posterior layers of the lid. Symptomatic and clinical improvement was observed, and there was no recurrence 2 years after surgery.

Entropion↗

Nasopharyngeal profile and velopharyngeal valve mechanism.

Proper management of velopharyngeal insufficiency requires an understanding of normal velopharyngeal anatomy and function. The present cephalometric study correlates the nasopharyngeal profile at rest with velopharyngeal function as observed by nasendoscopy and fluorographic and videofluoroscopic studies. Fifty-two normal individuals and 23 patients with insufficient velopharyngeal valves were examined. A correlation was found between nasopharyngeal profiles at rest and the closure patterns of the velopharyngeal valve. It was found that when existent, Passavant's ridge is subsequently formed where thick soft tissue corresponding to the superior constrictor muscle is found beneath the mucosa of the posterior pharyngeal wall at rest. Our conclusion is that Passavant's ridge is formed by the superior constrictor. The present study represents additional confirmation that differences in velopharyngeal closure patterns are the result of differences in anatomy. A biomechanical model of velopharyngeal valving is presented based on individual spatial muscular orientation and the hierarchical recruitment of the velopharyngeal muscles. This recruitment is progressive and is dependent on the effort required to achieve tighter velopharyngeal sealing.

Adult↗

Occult and overt submucous cleft palate: from peroral examination to nasendoscopy and back again.

Peroral examination of the soft palate is of greater value than generally recognized. The nasendoscopic examination provides essential information on the velopharyngeal valve physiology and pathology. However, nasendoscopy cannot be performed in individuals who are uncooperative such as young children, patients with personality disturbances or those mentally retarded, or in the presence of severe deformity of the nose. In these patients the peroral examination is of particular practical clinical application. Forty cases of occult and overt submucous cleft palate were included in the present study. We describe the contribution of systematic assessment of the soft palate intraorally, based on a correlation with nasendoscopic examination of the velopharyngeal valve in speech. An accurate peroral examination can provide additional information on abnormality of the velar musculature as well as the existence of Passavant's ridge. This information is particularly important in children who are too young for nasendoscopix examination, but because of their poor speech intelligibility, early diagnosis and treatment are imperative.

Adolescent↗

On the variability of velopharyngeal valve anatomy and function: a combined peroral and nasendoscopic study.

The oropharynx stripped of the tonsils and the excessive mucosal folds after the uvulopalatopharyngoplasty operation allows a closed observation of the outline of the pharyngeal muscles. Forty-two consecutive patients undergoing uvolopalatopharyngoplasty were subjected to peroral examination of the oropharynx combined with nasendoscopic examination of the velopharyngeal valve. At rest, the oropharynx of the patients with coronal closure patterns was found to be flat relative to the oropharynx of the patients with the other closure patterns. During closure of the velopharyngeal valve, an anteroposterior movement of the velum, forming the nasendoscopic coronal closure pattern, was observed in patients with a flat oropharynx. On the other hand, a medial movement of the pharyngeal walls was found, forming the circular or sagittal closure pattern seen in patients with a deep oropharynx. Our conclusion is therefore that a different muscular orientation is responsible for both the different pharyngeal configuration at rest and the different contribution of the lateral and posterior pharyngeal walls to velopharyngeal valve closure.

Adult↗

Study of the normal and insufficient velopharyngeal valve by the "Forced Sucking Test".

A thorough assessment of the velopharyngeal (VP) closure dynamics is important for therapeutic planning in patients with nasal speech. An additional diagnostic tool to the standard endoscopic examination of the VP valve, the "Forced Sucking Test" (FST) is presented. In this study, 110 patients with a normal VP valve and 40 patients with VP insufficiency were subjected to a comprehensive endoscopic examination. When existent, Passavant's ridge clearly appears in 80% of these cases during the FST. This is advantageous, since the ridge is often unseen during routine nasendoscopy. Passavant's ridge appears indistinguishable in shape and level during speech and FST. During FST, the bulge of the uvular ridge is clearly seen on the flat or concave nasal surface of the velum. In cases of diastasis of the velar musculature, the midline V-defect of the velum is clearly seen. The test is particularly important in children with concomitant adenoid hypertrophy. The findings are discussed in terms of their implications for the anatomy and physiology of the VP valve. FST is recommended as an additional and complementary part of the endoscopic examination of the VP valve.

Adult↗

Levator veli palatini muscle and eustachian tube function.

Thirty previously unoperated patients with submucous cleft palate, occult submucous cleft palate, and unilateral congenital paralysis of the levator veli palatini muscle were examined. All patients were subjected to a comprehensive otoscopic, endoscopic, audiologic, and tympanometric evaluation. A correlation was made between levator veli palatini muscle anomalies, eustachian tube orifice anomalies, and middle ear ventilation and disorders. Normal middle ear ventilation was found in 23 patients. Negative middle ear pressure that consequently normalized following treatment of coexisting sinusitis was found in 3 patients. Only in 4 patients was chronic middle ear disease found. In one of them, middle ear effusion disappeared following successful treatment of sinusitis. Our conclusion is that the levator veli palatini muscle has no significant function in the opening mechanism of the eustachian tube and must be considered as a velopharyngeal valve muscle only.

Adolescent↗

Solitary basal cell carcinoma in a child.

Basal cell carcinoma in children is rare. Its occurrence has been described in association with nevoid basal cell carcinoma syndrome, preexisting organoid nevus, and xeroderma pigmentosum. We present a case of solitary basal cell carcinoma in a 13-year-old boy with nonactive damaged skin or a genetically transmitted syndrome. The contribution of this case is to alert the physician to the possibility of basal cell carcinoma in children so that appropriate treatment may be initiated immediately and any delay avoided.

Adolescent↗

Subcutaneous V-Y advancement flap for closure of nasal tip defect.

Our experience with V-Y subcutaneous flaps for nasal tip closure after tumor resection in 10 patients is reported. This method has distinct advantages over previously used methods such as skin graft, rotation, or transposition flap. It allows primary closure of recipient and donor site without the formation of dog-ear or trapdoor deformity. It is easy to design, reliable, and offers good cosmetic results. This method is performed under local anesthesia as an office procedure. It is recommended to plastic surgeons for the closure of nasal tip defects.

Aged↗

One-stage reconstruction of a large upper lid defect in a newborn.

Full-thickness defects of the upper eyelids require immediate reconstruction to ensure protection of the cornea. A technique is described for a one-stage reconstruction of a large congenital defect of upper eyelid in a newborn. The reconstruction was composed of a mucosa-lined transpositional musculocutaneous flap. The advantages of this method over previous methods are discussed.

Coloboma↗

One-stage body contouring.

Body contouring for patients who have experienced massive weight loss requires multiple and extensive operations. A one-stage operative procedure was performed on 10 patients who have been followed for at least 18 months postoperatively. Combined brachioplasty, mammaplasty, abdominoplasty, and thigh reduction was carried out in one operation and proved to be safe, effective, and satisfactory. With this technique, we have achieved the goal of reducing the number of procedures while obtaining satisfactory results.

Abdomen↗

Reduction cheiloplasty for upper lip hemangioma.

A technique for reconstruction of the upper lip following excision of a cavernous hemangioma is presented. An apron-vermilion flap from the inner third of buccal side is elevated, allowing good exposure of the hemangioma. Following removal of the hemangioma, the excessive mucosa-vermilion flap is reduced to form an accurate upper lip shape. This method achieves a pleasing contour of the upper lip.

Child, Preschool↗

[Wound healing].

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Humans↗