By use of sophisticated techniques now available from the science of Speech Pathology, we can now document, quantify, and critically analyze the surgeon's reconstructive efforts in the oral cavity. Using these methods, we have evaluated the neurotized lateral arm free flap in six patients receiving oral reconstruction. Two of these are reported in detail. This study has provided a protocol that results in the objective analysis of swallowing, articulation, and range of tongue motion and sensation. All of these tests can be routinely performed by a speech pathologist to document both operative performance as well as patient progress in speech and swallowing. It would appear that we have quantified evidence that the neurotized lateral arm free flap may represent a significant step forward in reducing the morbidity of total and subtotal glossectomy by providing a truly functional reconstruction.

Adult↗

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Management of the mandible in oral cancer.

Modern head and neck surgery has focused on patient rehabilitation and restoration of form and function in the treatment of oral cancers. An important aspect of that process has been the conservation of the mandible in tumor ablation and the reconstruction of the mandible if segmental resection is indicated. This article outlines the science and clinical data behind rim mandibulectomy and the mandibular osteotomy and "swing" to gain access to tumors of the posterior tongues and pharynx. Additionally, the various methods of reconstruction of the mandible in use today as well as the advantages and disadvantages of each are addressed.

Algorithms↗

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Opioid agonist and antagonist bivalent ligands as receptor probes.

Bivalent ligands are molecules which contain two pharmacophores linked by a connecting chain (spanner). The present report describes the use of oxymorphamine (Oxy) and naltrexamine (Nal) as the opioid agonist and antagonist pharmacophores separated by a variable length spanner composed of succinyl-bis-oligoglycine. The agonist series, [CH2CO(Gly)nOxy]2, and antagonist series, [CH2CO(Gly)nNal]2, were synthesized (n = 0-4) and tested on the electrically stimulated GPI. All of the antagonist bivalent ligands (Nal) antagonized the effects of morphine, with the greatest potency enhancement (60 x) residing with the succinyl (n = 0) congener. A dramatically different SAR profile was observed in the agonist (Oxy) series where the greatest potency enhancement (17 x) occurs when n = 2. By contrast with the antagonist series the agonist bivalent ligand with n = 0 is equipotent to its monovalent agonist analogue. The significance of these results with respect to the possibility of discrete opioid agonist and antagonist recognition sites are discussed.

Animals↗

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Identification and assessment of velopharyngeal inadequacy.

PURPOSE: To review current literature with respect to the diagnosis and assessment of velopharyngeal inadequacy (VPI), including present knowledge about the most common causes of VPI. METHODS: Data sources include published reports over the past 20 years derived from computerized databases and bibliographies of pertinent articles and books. Indexing terms used were "velopharyngeal incompetence," "velopharyngeal inadequacy." "velopharyngeal insufficiency." CONCLUSION: VPI is most commonly associated with cleft palate, submucous cleft palate, and following adenoidectomy. The otolaryngologist can prevent the latter by preoperative identification of physical stigmata associated with VPI. Perceptual assessment is the criterion standard for diagnosis of VPI. Multiview videofluorography and flexible nasal endoscopy provide the best direct assessments to help plan and direct the optimal treatment of VPI.

Adenoidectomy↗

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Effects of the herbicide atrazine on Ambystoma tigrinum metamorphosis: duration, larval growth, and hormonal response.

We exposed larval tiger salamanders (Ambystoma tigrinum) reared in the laboratory from eggs collected from a prairie wetland in North Dakota to three concentrations of atrazine (0, 75, and 250 micrograms/L) in a static renewal test to determine the pesticide's effect on (1) plasma corticosterone and thyroxine concentrations, (2) larval size, and (3) days-to-stage at stages 2 and 4 of metamorphic climax. We found significant effects of atrazine on each of these response variables. Plasma thyroxine was elevated in both atrazine-exposed groups compared with the control group; plasma corticosterone was depressed in the 75 micrograms/L treatment compared with both the control and 250 micrograms/L treatment. Larvae exposed to 75 micrograms/L atrazine reached stage 4 later but at a size and weight comparable to the control group. By contrast, larvae in the 250 micrograms/L treatment progressed to stage 4 at the same time but at a smaller size and lower weight than larvae in the control group. These results indicate that the herbicide has the potential to influence tiger salamander life history. We present a model consistent with our results, whereby corticosterone and thyroxine interact to regulate metamorphosis of tiger salamanders based on nutrient assimilation and adult fitness.

Ambystoma↗

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Infections caused by Drechslera species: case report and review of the literature.

Organisms belonging to Drechslera species are rare causes of human infection and are considered opportunistic pathogens. Only 10 cases of human infection with these organisms have been reported in the literature; an additional case--that of a healthy young woman with chronic pansinusitis due to Drechslera spicifera causing nasal obstruction and erosion of bone--is described herein. This case was managed successfully by means of surgical debridement and therapy with amphotericin B and ketoconazole. A review of the literature suggests that infections caused by Drechslera species can in fact occur in a healthy host. Involvement of the paranasal sinuses and the central nervous system is common and potentially life-threatening. Appropriate therapy consists of the administration of amphotericin B, either alone or in combination with other antifungal agents, and surgical debridement when indicated.

Adolescent↗

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Reconstruction of the incompetent abdominal stoma.

The occasional patient who has an incompetent stoma that does not respond to traditional methods of treatment by the general surgeon or the ET nurse might be aided by the use of a customized procedure designed by the plastic and reconstructive surgeon.

Aged↗

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The disabled role, affluence, and the meaning of work.

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Attitude↗

PubMedDate not supplied

Positioning and splinting the burned patient.

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Bandages↗