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Biomedical subjects

N F Jones

Publications and source records attributed to N F Jones.

At least 91 records · Page 5Linked to original sources
PubMed1988

Subtemporal-infratemporal and basal subfrontal approach to extensive cranial base tumours.

A subtemporal-infratemporal and basal subfrontal approach for the removal of extensive, predominantly extradural cranial base neoplasms is described. This approach was used successfully in six of our patients. The advantages of this approach are extensive exposure of the anterior and mid-cranial base as well as the clivus, direct exposure and management of the ipsilateral petrous and cavernous internal carotid artery (ICA), and access to extracranial vessels for microvascular flap transfer. Disadvantages include prolonged operative time and less control of the contralateral petrous ICA. Six patients with extensive cranial base neoplasms had operations using this technique without any mortality or major permanent morbidity. The value of this approach to patients in terms of control or cure of extensive cranial base tumours has to be proven by long term follow-up.

Adolescent↗
PubMed1988

Immediate microvascular reconstruction of combined palatal and midfacial defects.

We describe a method for immediate one-stage reconstruction of combined palatal and midfacial defects using latissimus dorsi musculocutaneous free-tissue transfer. It has consistently provided healed wounds, restoration of palatal function, and preservation of facial contour while obviating the need for a palatal prosthesis. This reconstructive method, which uses only autogenous tissue, may offer a significant advantage in cases where more than a hemimaxillectomy is required, for compound defects resulting from the sacrifice of facial structures along with the maxillectomy, and in situations where the resection involves cranial base structures with a resultant need to separate the cranial contents from the oral and nasal cavities. Finally, it provides an alternative to prosthetic rehabilitation for the elderly patient with decreased or absent vision.

Facial Neoplasms↗
PubMed1988

Nasopharyngeal teratoma involving the temporal bone.

Teratoma is the most common nasopharyngeal tumor in neonates. The tumor is usually limited to the oropharynx and is manifest by stridor and respiratory distress. Complete excision affects a cure. An unusual case of nasopharyngeal teratoma extending into the temporal bone, causing facial paralysis and conductive hearing loss, in addition to stridor, is presented. Stridor was relieved by transoral partial excision shortly after birth. Complete removal of the tumor by way of a subtemporal and infratemporal fossa approach was performed at 14 months of age. The defect was filled with a rectus abdominis muscle graft with microvascular anastomoses. The facial nerve was reconstructed secondarily with a sural nerve graft. The patient has no recurrence tumor and has good facial function at 30 months. This case demonstrates the first known case of facial paralysis due to nasopharyngeal teratoma. The surgical approach for tumor removal: lateral infratemporal fossa dissection, and the method of reconstruction: free rectus abdominis muscle flap with microvascular anastomoses, had so far not been described in a patient this young.

Humans↗
PubMed1988

Epidemiologic study of the mallet finger deformity.

An epidemiologic survey of 24 members of a three-generation family revealed an unusually high incidence of mallet fingers. Twenty mallet fingers were found in seven family members by clinical examination, suggesting a familial predisposition to develop this deformity. Multiple mallet fingers (range, two to six) occurred in four individuals. Classification of these mallet fingers based on the mechanism of injury demonstrated a high incidence (85%) resulting from minimal trauma or occurring spontaneously. Symptoms and signs of bilateral carpal tunnel syndrome were documented in five family members with mallet fingers (71%), and three individuals with mallet finger deformities also had associated trigger fingers (43%).

Adolescent↗
PubMed1988

Persistent median artery as a cause of pronator syndrome.

Pronator syndrome may be caused by a persistent median artery that passes completely through the proximal median nerve and then gives origin to a vascular leash to the flexor muscles that compresses the nerve. A "double crush" compression of the median nerve caused by persistent median artery producing first a carpal tunnel syndrome and then a pronator syndrome is described.

Adult↗
PubMed1988

Direct monitoring of microvascular anastomoses with the 20-MHz ultrasonic Doppler probe: an experimental and clinical study.

The 20-MHz ultrasonic Doppler probe was used to determine its efficacy as a continuous monitoring technique for microvascular anastomoses. A 1-mm2 piezoelectric crystal embedded in a soft silicone sleeve was sutured directly to the blood vessel distal to the anastomosis. Using the dog femoral artery, simultaneous measurement of velocity and blood flow with an electromagnetic flowmeter established a direct correlation between flow and velocity with a 14 percent error at maximum flow and an 18 percent error at minimum flow conditions. The probe was then implanted in the rabbit femoral artery for 1 week (n = 3) and 4 weeks (N = 6), demonstrating that a continuous tracing could be obtained without injury to the vessel. Our clinical study included 63 patients undergoing free-tissue transfers monitored with the implantable probe for 7 to 29 days (average 10.5 days). Twenty-three flaps were buried. Two patients experienced loss of arterial tracing due to malfunction of the probe (3 percent). Three patients had a venous thrombosis with a present arterial tracing. There were no flap failures per se. All probes were removed without mishap, and there were no complications related to the probe. We conclude that the 20-MHz ultrasonic Doppler probe holds promise as a useful monitoring method.

Anastomosis, Surgical↗
PubMed1988

The "double barrel" free vascularized fibular bone graft.

A further modification of the free vascularized fibular bone graft is described in which a transverse osteotomy is made from the anterolateral aspect of the fibular shaft just distal to the entry of the nutrient artery. This produces two vascularized bone struts that may be folded parallel to each other but that remain connected by the periosteum and muscle cuff surrounding the peroneal artery and vein. The proximal strut is vascularized by both a periosteal and an endosteal blood supply, whereas the distal strut is vascularized by a periosteal blood supply alone. This so-called "double barrel" free vascularized fibular graft has been employed in three patients with segmental bone defects of the distal femur and in one patient with adjacent bony defects of the radius and ulna.

Adult↗
PubMed1988

Extensive and complex defects of the scalp, middle third of the face, and palate: the role of microsurgical reconstruction.

Twenty-one patients with gigantic defects of the scalp and middle third of the face and palate following excision of neglected or recurrent tumors, burns, and infections have undergone microsurgical reconstruction. Wide resection of the middle third of the face, orbit, and palate requires "complex" three-dimensional volume reconstruction, whereas extensive defects of the scalp and skull (exceeding 80 cm2) require coverage of the larger surface area soft-tissue defect and the exposed brain and dura. The latissimus dorsi free-muscle flap and split-thickness skin graft have become our methods of choice for extensive scalp and skull defects. The latissimus dorsi musculocutaneous free flap is preferable for reconstruction of complex palatal and external skin and orbital defects of the middle third of the face. Microsurgical free-tissue transfer reliably frees the oncologic surgeon from the constraints imposed by conventional reconstructive techniques and may therefore allow improved curative or at least palliative resection of these extensive tumors.

Adult↗
PubMed1988

Distribution of alexithymic characteristics within an adult outpatient population.

Utilizing the MMPI Alexithymia Scale (MMPI-AS), a retrospective study was undertaken to determine the distribution of alexithymia within an outpatient population. Approximately 7.64% of the outpatient population displayed the alexithymic trait. Analysis of alexithymia by sex revealed that 10.61% of males and 5.13% of females evidenced alexithymia. This does not correspond with other studies on the distribution of alexithymia within other nonpsychosomatic populations. Issues regarding the measurement instrument, distribution of alexithymia, as well as areas for further investigation are addressed.

Adult↗
PubMed1987

Microsurgery for macrodefects: microvascular free-tissue transfer for massive defects of the head and neck.

Despite defect location and the fear of creating complex massive defects, coverage of large areas of soft tissue loss, with or without exposed calvaria, dura, and brain, can be reconstructed reliably with microvascular free tissue transfer. This technique permits separation of the oronasopharynyx from the intracranial contents, coverage of dural grafts, restoration of composite tissue loss, and achievement of superior aesthetic results in a single stage. When choosing vascular anastomotic sites, free-flap transfer permits a greater latitude in flap orientation, tailoring, and inset than is possible when using fixed pedicled rotation flaps. When confronted with a deeply invasive or gigantic malignancy, a multidisciplinary team approach is optimal. The risk associated with sophisticated ablative and reconstructive operative procedures is justified when dealing with potentially curable lesions. The success of these extensive procedures is related not only to the functional result and the aesthetic appearance, but most importantly to the resultant quality of life they allow.

Adult↗
PubMed1987

Microsurgical revascularisation of the hand in scleroderma.

Raynaud's phenomenon is a prominent manifestation of systemic sclerosis (scleroderma) affecting the hand. The resulting digital ischaemia may progress to digital tip ulceration or gangrene. Four patients with scleroderma, presenting with severe unremitting unilateral pain in the hand, were evaluated by arteriography and plethysmography. In addition to the usual changes of narrowing and occlusion of the digital arteries themselves, arteriography revealed more proximal occlusion of the radial and ulnar arteries at the wrist and the superficial palmar arch. Plethysmography confirmed virtual absence of pulsatile digital blood flow. Two patients underwent microsurgical reconstruction of the radial and ulnar arterial inflow into the hand and the superficial palmar arch using reversed interposition vein grafts, with immediate subjective resolution of their severe pain and rapid healing of the digital ulcers. Both remain pain free 1 year post-operatively, and pulse-volume recordings have confirmed objectively the restoration of pulsatile blood flow to the fingers.

Aged↗
PubMed1987

Reconstruction of the cranial base following tumour resection.

Twenty-four patients have undergone resection of tumours involving the cranial base by a multidisciplinary team consisting of a neurosurgeon, ENT surgeon and plastic surgeon. The resultant defects of the cranial base have been reconstructed using local fascial flaps, transposition of local muscle flaps and microsurgical transfer of free muscle flaps. Indications for reconstruction have included obliteration of paranasal sinuses, coverage of tenuous dural repairs or dural grafts and separation of the nasopharynx from the dura of the frontal and temporal lobes and posterior fossa to prevent CSF leakage and meningitis.

Adolescent↗
PubMed1987

Surgery for scleroderma of the hand.

The role of hand surgery in systemic sclerosis (scleroderma) has been documented infrequently. Out of a series of 813 consecutive patients with scleroderma, 31 have had one or more surgical procedures on their involved hands--a total of 52 operations. Raynaud's phenomenon and digital tip ulcerations have been controlled medically by vasodilators and meticulous local wound care. Most digital ulcerations progressing to frank gangrene have been allowed to autoamputate to maximize the length of the salvaged finger, but 23 digital amputations have been performed when conservative measures failed. Digital sympathectomy and microsurgical revascularization have produced relief of symptoms in several patients. Severe flexion contractures of the proximal interphalangeal (PIP) joints, with secondary hyperextension of the metacarpophalangeal (MP) joints, have been effectively treated by arthrodesis of the PIP joints in 44 to 55 degrees of flexion. This has allowed both improved hand function and primary healing of dorsal ulcers in 53 PIP joints in 12 patients.

Adolescent↗
PubMed1987

Upper limb salvage using a free radial forearm flap.

Microsurgical transfer of a skin flap salvaged from a nonreplantable upper extremity that would otherwise be discarded may provide essential soft-tissue coverage of the amputation stump, so maintaining a functional range of motion in the elbow joint. A radial forearm free flap measuring 24 cm long by 9 cm wide was salvaged from the degloved forearm skin of a patient who sustained a proximal forearm amputation that was considered unsuitable for replantation. This allowed coverage of the proximal radius and ulna, preservation of a functional elbow joint, and successful fitting of a below-elbow prosthesis.

Amputation Stumps↗
PubMed1987

Alexithymia in chronic bronchitis/emphysema: personality characteristics and illness attitudes.

Personality characteristics and illness attitudes of alexithymic and nonalexithymic chronic bronchitis/emphysema patients were assessed using the Minnesota Multiphasic Personality Inventory (MMPI) along with supplementary scales and the Respiratory Illness Opinion Survey (RIOS). Two validity scales, three clinical scales and one supplementary scale from the MMPI along with one illness attitude category from the RIOS discriminated alexithymic and nonalexithymic patients. These findings are disparate from those observed in an asthmatic population and point to an interplay between illness type and alexithymia in terms of personality and illness attitudes.

Affective Symptoms↗
PubMed1987

Free jejunal transfer for reconstruction of the laryngopharynx.

Reconstruction of the laryngopharynx and cervical esophagus presents difficult problems. We embarked on a program using free jejunal transfer for such reconstruction. Thirty-two patients have been evaluated, with a mean follow-up of 16.7 months. Thirty-four transfers were undertaken--14 as primary repair and 20 after the failure of alternate methods. Twenty-six patients were able to achieve oral feeding. There was one immediate and one delayed failure of the graft. Twelve fistulas developed, seven of which healed spontaneously in less than 2 weeks. Four patients experienced complications related to the microvascular anastomosis which required repair. Six patients had significant dysphagia; four of these had side-to-end distal anastomosis. This technique had been abandoned and improvement resulted. We conclude that free jejunal transfer is an expeditious, safe, and reliable method of reconstruction for patients who require total laryngopharyngectomy.

Adult↗