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Biomedical subjects

M H Newman

Publications and source records attributed to M H Newman.

At least 19 recordsLinked to original sources
PubMed1995

Outpatient conventional laminotomy and disc excision.

STUDY DESIGN: This study analyzes the clinical records of 75 consecutive cases of outpatient disc excision performed by the author on a prospective basis. OBJECTIVES: The results were analyzed to determine the practicality of performing conventional outpatient laminotomy on an outpatient basis. SUMMARY OF BACKGROUND DATA: Outpatient disc excision has not been reported in the literature. Current awareness of the cost constraints of medical practice and the options of other outpatient disc procedures, such as microdiscectomy and percutaneous discectomy, make this a timely subject for analysis. METHODS: The clinical data were collected prospectively on 75 consecutive patients operated on as outpatients by the author. RESULTS: No complications or problems were experienced in the performance of this procedure in the outpatient setting. Two complications that did occur were neither due to the outpatient setting nor influenced in any way by the outpatient setting. CONCLUSIONS: Outpatient surgery is a practical alternative for selected patients requiring disc surgery.

Adult↗
PubMed1995

The influence of bony architecture on fixed membranous bone graft survival.

The aim of this study was to examine the influence of membranous bone graft architecture on graft survival. Eighteen adult New Zealand rabbits underwent full-thickness harvesting of their zygoma, which was then divided into two parts, resulting in a wider, thicker anterior graft and a tapered posterior graft. The grafts were then rigidly fixed, one to each nasal bone, using titanium lag screws. On postgrafting days 15 and 45, 3 animals each were killed. The remaining 12 animals were killed on day 90. The graft, graft-host interface, and contralateral zygoma were assessed volumetrically, histologically (nondecalcified), and stereologically. Volumetrically, the anterior (thicker, wider) grafts demonstrated 100% survival while the posterior (thinner, more narrow) grafts demonstrated 80% survival (p = 0.004). Histologically, the anterior grafts demonstrated less resorption and porosity and greater labeling activity. At the graft-host interface, the anterior grafts exhibited a 2.5-fold increase in full incorporation of the grafts, and the posterior grafts had almost twice the incidence of nonincorporation. Stereological measurements, including interlabel width (20.3 microns anteriorly, 18.9 microns posteriorly), confirmed the enhanced survival of the anterior grafts. Using multiple forms of analyses, this study demonstrates that membranous bone graft architecture influences graft survival. To assist in understanding these differences, we also analyzed the normal contralateral zygoma. While the anterior and posterior halves had a relatively constant amount of bicortical bone, the thicker grafts had a proportionally greater trabecular component (i.e., increased diploë-to-cortical ratio). In the rabbit model, differences in membranous bone thickness imply differences in the cancellous portion of the graft, thereby influencing ultimate graft survival.

Animals↗
PubMed1994

Metopic synostosis: evaluation of aesthetic results.

Analysis of intermediate- and long-term results of surgical treatment of metopic synostosis is lacking. We therefore retrospectively studied 23 patients with metopic synostosis (14 males, 9 females) who have been followed from 3 months to 8.1 years (mean 42.5 months) after operation. Age at first operation ranged from 2 to 56 months (mean 8.2 months), with 15 patients operated on before 6 months and 8 after 7 months. Fronto-orbital remodeling and calvarial vault reshaping with floating forehead techniques were carried out in all patients. Stabilization of bony segments was accomplished with microplates and screws in 7 patients (30 percent), wires in 15 (65 percent), and absorbable sutures in 1. Complications included minor wound dehiscence (n = 1), seizures (n = 1), and increased intracranial pressure (n = 1). Postoperative photographic documentation of surgical results was available in 17 of the 23 patients. Aesthetic outcome in these 17 patients was graded (I = none or minor contour irregularities; II = moderate; and III = severe) by one of the authors (Cohen) and by a lay panel (n = 3) according to the degree of residual cranio-orbital deformity. Judged by the surgeon, grade I results were present in 53 percent, grade II in 35 percent, and grade III in 12 percent. To date, total reoperation (reoperative fronto-orbital remodeling and calvarial vault reshaping) was necessary in 2 patients (9 percent), one of whom had signs of increased intracranial pressure 3 years after the original craniofacial procedure, while partial reoperation (temporal cranioplasty) was carried out (n = 2) or recommended (n = 3) in another 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1992

Anterior lumbar interbody fusion for internal disc disruption.

Anterior lumbar interbody fusion was performed as the primary surgical procedure for 36 patients with internal disc derangement. Patients were selected on the basis of clinical complaints, discography, and magnetic resonance imaging results. Twenty-eight patients underwent a one-level fusion and eight patients had a two-level fusion for a total of 44 levels. Autogenous graft was used in all cases. Clinical results were categorized as success or failure based on return to work or activities of daily living, drug usage patterns, and complaints of pain. Thirty-one patients (86.1%) had a successful clinical result and five patients (13.9%) had an unsuccessful clinical result. Based on flexion-extension radiographs fusion was achieved in 32 patients (88.9%). Forty of the forty-four levels (90.9%) fused. Complications include one each of: pulmonary embolus, retrograde ejaculation, wound hematoma at the donor site, and perioperative graft extrusion.

Adult↗
PubMed1989

The failure of ethylene oxide gas-sterilized freeze-dried bone graft for thoracic and lumbar spinal fusion.

Thirty-seven patients underwent posterior and/or posterolateral spinal fusion using ethylene oxide gas-sterilized freeze-dried bank bone graft. Thirteen patients had discogenic back pain, eight with prior failed laminectomy procedures, and five undergoing initial spinal surgery. Six patients had isthmic spondylolisthesis, three with associated radicular complaints, and two patients had degenerative spondylolisthesis. Seven patients with spinal fractures and nine patients with scoliosis underwent spinal fusion with associated instrumentation. Pseudarthroses were detected in 28 patients (76%), and 18 patients (49%) underwent pseudarthrosis repair procedures using autogenous iliac bone graft. At surgery, the prior gas-sterilized freeze-dried bone graft was noted to have been almost completely resorbed. Ethylene oxide sterilization has been found experimentally in animal models to damage the osteoinductive ability of bone grafts. Ethylene oxide gas-sterilized freeze-dried bank bone graft is inferior to autogenous bone graft or bank bone graft preserved and/or sterilized by other methods. Its use in thoracic or lumbar posterior or posterolateral fusion cannot be recommended.

Adolescent↗
PubMed1985

Congenital hemifacial hyperplasia: an embryologic hypothesis and case report.

Congenital hyperplasia is a developmental disorder characterized by marked unilateral asymmetry. The structural disproportions from one side to the other far exceed variations commonly seen in the normal population. Classically, as first described in 1836, the overgrowth of tissue is restricted to one-half of the body, including the extremities. In other cases the hyperplastic enlargement involves segmental areas of the body, such as the hemifacial skeleton and an extremity. A case report is presented, and the clinical characteristics of 192 cases of congenital hyperplasia in the literature are briefly reviewed. Use of the word hyperplasia to describe the condition (rather than hypertrophy) is encouraged. The authors propose a new embryologic hypothesis: asymmetrical development of the neural fold and hyperplasia of the neural crest cells are said to form the basis for the disorder. The rewards, risks, and limitations of reconstructive surgery over a 10-year period are discussed.

Child, Preschool↗
PubMed1983

Transcoronal removal of an atypical orbitoethmoid osteoma.

Craniofacial osteomas are lesions of bone that most commonly occur in the paranasal sinuses. Characteristically they remain dormant or slowly enlarge but remain asymptomatic. The more rapidly expanding tumor types may extend to adjacent structures, but signs and symptoms of such involvement are rare before the third decade. Presented is a patient with an ethmoid osteoma associated with a 2-year history of progressive proptosis first noticed at age 14. The operative approach afforded through a transcoronal incision combines excellent surgical exposure with hidden scar.

Adolescent↗
PubMed1981

Congenital alar field defects: clinical and embryological observations.

Congenital malformations of the nasal ala may occur as isolated unilateral nasal alar defects or as part of more severe facial clefting syndromes. The embryologic significance of the isolated alar deformity seems separate from other craniofacial deformities and justified comment. Clinical examples of isolated nasal alar malformations are correlated with a study of 60 human embryos ranging from seven to 10 weeks gestation. These studies indicate that the nasal and alar developmental fields each have a separate critical time during which cells are most susceptible to altered development.

Female↗
PubMed1977

Posterior table fractures of the frontal sinus: I. An experimental study.

Experiments using cats were performed to examine the natural history of posterior table fractures of the frontal sinus and the methods available for treatment. Elevation of depressed fractures and obliteration by either fat or osteoneogenesis and fibrosis were the modalities of treatment used. Comparisons were made with untreated controls. Fascia reinforcement of the dura and plugging of the nasofrontal duct were variables. The nasofrontal duct is critical in the natural history of these injuries. All fractures of the posterior table heal if drainage into the nose is maintained. Fractures which are elevated heal by bony union with associated mucosal and dural healing. Loose fragments of the posterior table heal if left in place. Mucoceles form if the nasofrontal duct is obstructed, if mucosa is inadequately removed during obliteration and, in some instances, where islands of mucosa are isolated by mucosal laceration. Viable adipose tissue in the sinus prevents significant ingrowth of mucosa from the nasofrontal duct. Growth of mucosa into fracture lines was not a problem. Both adipose transplants and intrasinus fascia reinforcement appeared to contribute to well defined posterior table healing.

Animals↗
PubMed1976

Tuberculosis of the larynx.

Tuberculosis of the larynx, once a common disease, has become quite rare with the advent of anti-tuberculous chemotherapy. In the pre-antibiotic era two modes of laryngeal infection were recognized; bronchogenic and hematogenous. The literature is briefly reviewed. Thirteen patients in the past 15 years in whom tuberculous laryngitis was diagnosed upon indirect laryngoscopy by members of the University of Michigan Department of Otorhinolaryngology are presented. Bronchogenic infection was present in 11, and in two patients the disease was consistent with hematogenous spread. Tissue biopsy from a case of bronchogenic contamination demonstrated epithelioid tubercles, while numerous subepithelial acid-fast bacilli without typical tuberculous histological change were present in a case of hematogenous laryngeal infection. A case of cicatricial laryngeal stenosis was successfully treated surgically by laryngofissure, excision of fibrosis with arytenoidectomy, and free mucous membrane grafting. Finally, the initial subtle presentation of many of our patients emphasizes the importance of a consideration of tuberculosis in the differential diagnosis of chronic laryngitis.

Adult↗
PubMed1976

Arytenoidectomy revisited.

The spectrum of disabilities attendant to laryngeal paralysis range from mild hoarseness to complete upper airway obstruction depending upon the static position of the paralyzed cord or cords. The most distressing disabilities are those of bilateral vocal cord paralysis in which both vocal folds are fixed in the midline resulting in severe upper airway obstruction. Clearly the most acceptable solution to the problem of persistent laryngeal paralysis is through the establishment of normal neuromuscular integrity by vagal repair or neural transfer techniques. While electromyographic evidence of reinnervation and some restoration of cord motion has been described, synchronous neuromuscular activity is, at best, unpredictable and generally unsuccessful. Successful reinnervation procedures depend in part on early repair and herein lies a disparity between experimental work and its clinical applicability. Given the realities of delays in diagnosis and the unpredictability of operative reinnervation of the paralyzed larynx, we rely on alternative methods of improving the compromised glottic airway consequent to bilateral recurrent nerve paralysis of the larynx. During the period 1962 through 1974, 23 patients with complete bilateral paralysis of the larynx have been treated by the posterior extralaryngeal approach originally described by Woodman. The following is a description of the operative technique utilized with technical modifications which we consider important in enhancing operative results.

Adolescent↗