Biomedical subjects

E J Ivy

Publications and source records attributed to E J Ivy.

5 recordsLinked to original sources

PubMed1996

Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies.

Presented is a prospective study comparing limited SMAS (lateral SMASectomy), conventional SMAS, extended SMAS, and composite rhytidectomies. Randomized patients received either a limited SMAS or conventional SMAS face lift on one side and an extended SMAS or composite rhytidectomy on the other. All procedures were performed at Manhattan Eye, Ear and Throat Hospital in accordance with their well-defined surgical descriptions. Postoperative courses were followed clinically for at least 1 year. Photographs were taken preoperatively and at 6 and 12 months postoperatively. Photographs were reviewed by three independent experienced face lift surgeons. The study comprises 21 patients, 20 women and 1 man, with a mean age of 59 years (range 47 to 70 years). Nineteen patients underwent primary rhytidectomies; two underwent secondary face lifts. For the first 12 patients, each had an extended SMAS procedure performed on one side; on the other, 7 had a conventional SMAS and 5 had a limited SMAS (lateral SMASectomy) face lift. In the last 9 patients, a conventional SMAS was carried out on one side in 8, a limited SMAS in 1, and on the opposite side, a composite rhytidectomy was performed. Complications were few. Temporary weakness of the buccal branch of the facial nerve occurred in 2 patients on the side of the more extensive surgery. On the operating table at completion of the surgery, there was more improvement in reversal of midfacial ptosis and flattening of the nasolabial folds with both extended SMAS and composite rhytidectomies. The composite flap had the most dramatic effect on the nasolabial folds and oral commissure. After 24 hours, once swelling developed and facial motion became reactivated, the noticeable differences in the midface and nasolabial folds were lost. No discernible differences in facial halves were noted again. Differences between facial sides on the 6- and 12-month postoperative photographs were not detectable. We conclude that for routine facial plasty, comparable clinical outcomes are obtained at 6 months and 1 year with limited (lateral SMASectomy) and conventional SMAS face lifts compared with extended SMAS and composite rhytidectomies. All procedures are lacking in their improvement of midface ptosis and the nasolabial folds. The increased surgical risks, morbidity, and convalescence associated with those more extensive procedures do not seem to be warranted in the average patient.

Aged↗

PubMed1995

Malar augmentation with silicone implants.

This study is a retrospective review of all consecutive surgeries involving insertion of silicone malar implants performed at the Manhattan Eye, Ear and Throat Hospital from January 1, 1985 to April 30, 1993. Sixty-four patients underwent placement of 126 silicone malar implants. Three different sizes were utilized: 23 size 1, 85 size 2, and 18 size 3. Eleven patients underwent unilateral implant placement, all for reconstructive purposes. The average and median ages of the patients were 43 and 44 years, respectively, with a range of 18 to 83 years. Malar implants were inserted for the following reasons: hypoplasia, post-traumatic deformity, post-tumor resection deformity, and correction of hemifacial microsomia. In 79 percent of the patients, malar augmentation was performed in conjunction with other surgical procedures. All implants were placed in a subperiosteal pocket by either the intraoral, subciliary, or preauricular approach. Forty-one percent were fixed in place by percutaneous sutures. Malar augmentation with silicone implants for both aesthetic and reconstructive purposes is an increasingly common surgical procedure. Good results are obtained with few complications. Infection is rare even with transoral placement. Silicone malar implants should be placed in a subperiosteal pocket and can be inserted safely through various routes. Malpositioning of implants is infrequent, and fixation sutures are not required. The most common problem is improper size selection. Patient satisfaction is high, in that no patient underwent permanent removal of a malar silicone implant once inserted.

Adolescent↗

PubMed1990

Nonendocrine cancer of the pancreas in patients under age forty years.

In an attempt to determine the natural history of ductal adenocarcinoma of the pancreas in patients under 40 years of age, we reviewed the surgical outcomes of all such patients seen at the Mayo Clinic from 1970 to 1985. Histologic sections were reviewed; islet cell tumors and cystadenocarcinomas were carefully excluded. Twenty-six patients were identified. Their mean age was 34 years, with only one patient less than 25 years old. Symptoms included primarily abdominal pain, weight loss, and jaundice. One third of patients had a recent or past history of pancreatic disease including pancreatitis, pseudocysts, benign cystadenoma, and choledochal cyst. The tumor was located in the head of the gland in 62% of patients. "Curative" resections were possible in only three patients (12%); the remaining patients underwent palliative bypass (38%), biopsy alone (42%), or a palliative resection (8%). The hospital mortality rate was 12%, with actual 1-, 2-, and 5-year survival rates of 19%, 8%, and 4%, respectively, with a median survival of 4 months. The only long-term survivor underwent biliary bypass at age 15 years for a large neoplasm in the head of the gland; despite biopsy-proved liver metastases at that time, she continues to do well 5 years later. Histologic review indicated this tumor to be a "solid and papillary neoplasm of the pancreas." Ductal adenocarcinoma of the pancreas in young patients is an aggressive tumor with a poor prognosis behaving much like ductal adenocarcinoma in older patients (greater than 40 years). In rare instances a more favorable outcome can be expected when a solid and papillary neoplasm is found.

Adolescent↗

PubMed1988

Coverage of chest wall and pelvic defects with the external oblique musculofasciocutaneous flap.

The external oblique muscle, its fascia, and overlying skin have comprised flaps that have been used successfully in reconstructive surgery of various defects in the past. This flap provides good coverage for lower and upper chest wall defects to the level of the ipsilateral fourth rib. It provides skin of a similar color and texture and of large quantity. The skin of the flap is innervated; thus, sensation can be maintained. The remaining flat abdominal musculature and fascia maintain the integrity of the abdominal wall after transposition. We demonstrate that the external oblique musculofasciocutaneous flap can also be rotated in an inferior direction to close large hemipelvectomy defects in the absence of the usual ipsilateral thigh musculature.

Abdominal Muscles↗

PubMed1985

Transmembrane potential of renal papillary epithelial cells: effect of urea and DDAVP.

To define how renal papillary epithelial cells respond to wide changes in the ionic and osmotic composition of their environment, measurements were made of the transmembrane potential differences (PD) of rat renal papillary epithelial cells in vitro in media containing 100 mM NaCl, 100 mM KCl, 1.5 mM CaCl2, and 1 mM MgSO4 plus varying amounts of urea and/or sucrose up to 1,400 mM. Glass microelectrodes (resistance 25-75 M Omega) were used. With added sucrose, no change in PD from the initial value of -9.3 +/- 1.3 (SD) mV (n = 29) (cell interior negative) was found. With added urea, alone or while osmolality was maintained nearly constant with sucrose, the PD changed in a triphasic manner, depolarizing to -5.3 mV at 50 mM urea, hyperpolarizing to -20.0 mV at 150 mM urea, and then depolarizing again to -5.5 mV at 1,400 mM urea. When bath potassium was decreased to 10 meQ/liter (choline replacement) the PD hyperpolarized to -46.9 +/- 5.0 (SD) mV (n = 32). DDAVP, a nonpressor vasopressin analogue, and 8-bromo-cAMP depolarized the membrane to -5 mV in the presence of urea but did not change PD when urea was absent. These observations suggest an interaction between urea and ionic movement or conductance in rat renal papillary epithelial cells.

Animals↗