The relationship of social attitudes to manifest needs.
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Achievement↗
Biomedical subjects
S R Baker
Publications and source records attributed to S R Baker.
Vocational indecisiveness and decisiveness and level of grade expectation as related to perception of university environmental press.
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Achievement↗
Orbital fat preservation in lower-lid blepharoplasty.
In the last 4 years, there have been a few reports concerning unconventional management of the fat posterior to the orbital septum (intraorbital) as well as periorbital fat located superficial to the orbital septum in a plane both superficial and deep to the orbicularis oculi muscle. With reference to intraorbital fat, some reports suggest that this fat be preserved and mobilized to other areas to recontour the lower lid, while other authors suggest repositioning the fat within the bony orbit. To address these new concepts, a discussion of the theories behind these approaches is needed.
Adipose Tissue↗
Development of Graves orbitopathy after blepharoplasty. A rare complication.
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Adrenal Cortex Hormones↗
Suture contouring of the nasal tip.
Scoring, morselizing, and resecting the alar cartilages in an attempt to modify the position and shape of the nasal tip may lead to postoperative distortions of the lobule. Contour grafts have the disadvantage of asymmetries, visible irregularities, and absorption. For these reasons, surgeons have adopted suture techniques as the primary method of recontouring the alar cartilages. My philosophy in dealing with mild to moderate tip deformities consists of the following principles: (1) limited or no resection of cartilages; (2) no scoring or morselization of alar cartilages, which produces irreversible change and unpredictable results; (3) use of support grafts in the form of columellar struts and lateral crural battens to supplement structure and correct intrinsic alar cartilage weaknesses; (4) reliance primarily on the use of sutures to recontour and position the tip; and (5) limited use of contour grafts for situations that cannot be corrected with sutures and support grafts. Arch Facial Plast Surg. 2000;2:34-42
Adult↗
The extended Abbe flap in the reconstruction of complex midfacial defects.
The Abbe flap is most commonly used to repair full-thickness defects of the lip that do not involve the commissure. This well-perfused axial flap is based on the labial branches of the facial artery. The inferior labial vessels have been shown to support a cutaneous territory, including the entire lower lip, chin, and submental skin. Defects extending beyond the confines of the upper lip may be reconstructed with an extended lip switch flap that is based on the inferior labial artery. This "extended" Abbe flap allows functional and cosmetically acceptable repair of the upper lip, medial cheek, columella, and nasal sill. Case presentations illustrate the technique and outcome.
Aged↗
Reconstruction of nasal alar defects.
OBJECTIVE: To evaluate aesthetic and functional results of reconstruction of the nasal alar subunit using free cartilage grafts with an interpolated cheek or forehead flap and a vascularized mucosal flap when required. SETTING: University-based facial plastic surgery practice. PATIENTS: A case series of 50 patients with primary alar defects undergoing nasal alar reconstruction. MAIN OUTCOME MEASURES: Observer's and patient's rating of the final results, patient's rating of breathing and level of self-consciousness, and medical record review of complications. RESULTS: Most aesthetic outcomes were excellent to good. Breathing from the reconstructed side can be returned to preoperative status in most of these patients. CONCLUSION: Staged reconstruction of the nasal ala using free cartilage grafts, interpolated cheek or forehead and mucosal flaps when necessary, result in a highly aesthetic and functional outcome in most patients.
Adult↗
Treatment of head and neck melanoma, lentigo maligna subtype: a practical surgical technique.
Melanoma with the lentigo maligna histological pattern often provides a significant and difficult challenge to the head and neck surgeon. The lentigo maligna subtype is the most common type of melanoma on the head and neck. This potentially lethal form of cancer is associated with greater nonvisual lesional extension that is often not clinically apparent. Failure to excise the entire lesion results in a higher risk of local recurrence and a poorer prognosis. The staged excision technique described herein results in histological interpretation of 100% of the peripheral margins using formalin-fixed vertical sections. Definitive local excision and soft tissue reconstruction are performed in a subsequent stage, with an assurance that 100% of the peripheral margins have been evaluated and interpreted as free of disease.
Female↗
Vocal rehabilitation of tracheoesophageal speech failures.
Twenty-three tracheoesophageal speech failures were prospectively evaluated by clinical parameters and transnasal air insufflation at 3 L per minute. The results of testing allow an accurate indication of the etiology of the speech failure. Pharyngoesophageal spasm accounted for 79% of the failures; hypopharyngeal strictures for 26%. One patient was found to have both pharyngoesophageal spasm and a hypopharyngeal stricture. A modified air insufflation test result greater than 20 mm Hg reliably identified all tracheoesophageal speech failures prior to tracheoesophageal puncture. Clinical parameters were not helpful in identifying speech failures. Successful treatment of the specific etiology of the failure resulted in a reduction of the measured intraesophageal pressures. Ninety-one percent of the tracheoesophageal speech failures were successfully rehabilitated and achieved fluent tracheoesophageal speech. Successful rehabilitation was associated with long-term tracheoesophageal speech use.
Esophageal Spasm, Diffuse↗
Fundamentals of expanded tissue.
The relatively recent advent of tissue expansion for medical purposes precludes the availability of extensive knowledge concerning the physiologic and histologic changes that occur during controlled expansion of the skin. This paper reviews the basic science and clinical research that has been conducted to investigate the changes and summarizes the findings. It can be concluded that flaps harvested from skin previously expanded have an improved survival rate compared to similar flaps developed in nonexpanded skin. Increased vascularity to either the skin, the capsule that forms around the expander, or both probably in some way accounts for the improved survival. Controlled expansion of the skin results in the creation of additional new skin at the expense of thinning the dermis and subcutis. This thinning is associated with an overall decrease in tensile strength of the expanded skin. The increase in surface area gained from skin expansion probably varies according to the type of skin expanded and the underlying tissues that serve as a foundation for the expander.
Humans↗
Nasopharyngeal carcinoma: clinical course and results of therapy.
Ninety-nine patients with carcinoma of the nasopharynx were reviewed. No significant relationship was found between T classification and survival or between tumor cell type and survival. The presence of regional metastases, however, did influence the outcome of therapy. A 5-year survival of 34.4% was recorded for patients without nodal disease in contrast to 14% for patients with massive lymphadenopathy or bilateral cervical metastases. The significance of regional metastases is supported by the relationship between survival and disease stage. The 5-year survival for stage I was 67%, while the average survival for stages III and IV was 21%. The average 3- and 5-year survivals for the entire series of patients were 36.2% and 23.9%, respectively. Early lesions confined to the primary site have the greatest chance of cure, but even advanced disease with bone destruction or cranial nerve involvement may be controlled with radiotherapy in some cases. Patients who develop cervical metastases following successful control of nasopharyngeal tumor may be cured by radical neck dissection. Two (28.6%) of seven patients undergoing surgical treatment survived for 10 years following neck dissection.
Adolescent↗
Intraarterial infusion chemotherapy for head and neck cancer using a totally implantable infusion pump.
Intraarterial infusion chemotherapy has not been widely accepted for the treatment of head and neck cancer due to the high rate of complications it involves. To avoid these complications, a totally implantable infusion pump has been developed to achieve continuous low-level drug delivery for long periods of time. The pump is implanted in a subcutaneous pocket and connected to a permanent, indwelling, arterial catheter. It can be repeatedly refilled with chemotherapeutic agents by hypodermic needle injection through the skin and through a self-sealing septum located at the entry to the pump. Refilling the pump recharges an inexhaustible power source for the next delivery cycle. Preliminary results suggest that long term intraarterial infusion chemotherapy for the treatment of head and neck cancer is practical for outpatients.
Antineoplastic Agents↗
Manifestations and management of laryngoceles.
Six cases of laryngocele are reported including 2 bilateral, external laryngoceles, 1 internal laryngocele associated with amyloidosis, and 3 combined laryngoceles. Laryngoceles occur predominantly in males. Cervical mass and hoarseness were the most common signs and symptoms. Bilateral, external laryngoceles that decompress spontaneously when intralaryngeal air pressure returns to normal were managed conservatively. Combined and internal laryngoceles should be removed surgically through an external, lateral neck approach. This approach is preferable to anterior laryngofissure because it avoids trauma to the anterior commissure and the true vocal cords. In addition, blunting of the anterior commissure and the risk of subglottic stenosis are avoided.
Adult↗
Squamous cell carcinoma of the maxillary sinus: analysis of 66 cases.
A retrospective review was performed of 66 patients with squamous cell carcinoma of the maxillary sinus. The majority of patients presented with tumors classified as T3 (31.8%) and T4 (54.5%). Seven (10.6%) patients presented initially with neck metastases and 13 (19.7%) patients subsequently developed regional disease. For the 66 patients studied, the observed 5 and 10 year actuarial survival rate was 27.3% and 20.7% respectively. The presence of cervical metastases, particularly when they developed subsequent to initial therapy, was associated with a poorer survival rate. Five year survival rate for patients without cervical metastases was 32.6% in contrast to 28.6% for patients initially presenting with nodal disease and 7.7% for patients who subsequently developed regional metastases. Overall, 5-year survival rate for all patients with cervical metastases was 15.0%. A combined treatment regimen (surgery and radiation therapy) appeared to be superior to single modality therapy. A 58.0% observed 5-year actuarial survival rate was achieved with combined therapy. Surgery or radiation therapy when used alone as a single modality resulted in a 5-year survival rate of 20.0% and 15.7% respectively.
Actuarial Analysis↗
Intraarterial chemotherapy for head and neck cancer, Part 1: Theoretical considerations and drug delivery systems.
The principal objective of regional chemotherapy is tumor cell kill. The rationale for regional delivery is based on the steep dose/response curve exhibited by most antineoplastic agents. Intraarterial (IA) chemotherapy has the potential advantage of increased drug concentration at the tumor site, decreased systemic drug levels, and continuous tumor cell exposure to an antineoplastic agent. Despite these advantages, the use of IA chemotherapy has not been universally accepted. This is in part due to the difficulties associated with establishing and maintaining arterial access. Considerable improvement in the techniques and efficacy of regional therapy for head and neck cancer will be necessary before there is widespread clinical acceptance. These improvements must be based on anatomic and pharmacologic factors that ensure success of regional therapy. In addition, the development of safe, reliable delivery systems will be necessary. Part 1 of this two-part article will review these factors and discuss delivery systems.
Antineoplastic Agents↗
Mohs surgery: techniques, indications, and applications in head and neck surgery.
Mohs surgery, as it has evolved since its inception by Dr. Mohs, is a technique for removal of certain cancers using careful, precise microscopic marginal control. The contemporary technique using fresh tissue is detailed, illustrating advantages that include maximal conservation of normal surrounding tissue and structures, an extremely high cure rate, and a tumor-free defect which can be reconstructed immediately. The indications and applications for Mohs surgery, once limited to large recurrent basal cell carcinomas, have expanded to include several cutaneous and paracutaneous neoplasms. These, with an emphasis on certain basal cell carcinomas, are discussed in detail. With better understanding of the Mohs technique, its indications, applications, and advantages, an interdisciplinary approach to certain cutaneous and paracutaneous neoplasms is proposed.
Carcinoma↗
Intraarterial chemotherapy for head and neck cancer, Part 2: Clinical experience.
Despite almost 3 decades of experience, the use of intraarterial (IA) chemotherapy for the treatment of head and neck cancer is not universally accepted. The overall reported response rates are not substantially different from the therapeutic results obtained with systemic therapy. The additional complications associated with establishing and maintaining arterial access have further dampened enthusiasm for this approach. It is clear that considerable improvement in the techniques and efficacy of IA chemotherapy is necessary. This second and last part of this article considers the past and present clinical experience with IA therapy in the treatment of head and neck cancer and explores future developments.
Antineoplastic Combined Chemotherapy Protocols↗
Closure of large orbital-maxillary defects with free latissimus dorsi myocutaneous flaps.
The treatment of advanced cancer of the maxillary sinus often requires extensive ablation and orbital exenteration that results in large full-thickness defects of the upper cheek and orbital regions. Reconstruction of such defects with local flaps is usually difficult because of the need for a large flap. Several regional flaps such as the deltopectoral flap, the temporal flap, and the shoulder flap may be used, but these techniques frequently require surgery in stages and result in severe deformity of the donor site. The island pedicled, pectoralis major myocutaneous flap may be rotated up to the orbital region; however, the uncertain blood supply to the skin in the distal area of the pectoralis may cause unexpected marginal necrosis of the flap. Reconstruction of large orbital-maxillary defects can readily be accomplished in one stage using microsurgical free transfer of latissimus dorsi myocutaneous flaps. The thoracodorsal artery and vein that form the nutrient pedicle of the flap approaches 2 mm in external diameter and up to 10 cm in length, allowing greater versatility in head and neck reconstruction. The muscle may be used to fill the orbital and maxillary cavities and will accept a skin graft on its deep surface. The donor defect is closed primarily and the resulting scar is well concealed beneath the arm. If necessary, extremely large flaps may be transferred by harvesting the entire latissimus dorsi muscle and the overlying skin based on the thoracodorsal system.
Abdominal Muscles↗