Treatment of neck laxity with a Gore-Tex cervical sling for patients with heavy neck tissues.

Treatment of neck laxity is a challenging problem for facial plastic surgeons. Many factors may contribute to this problem, including relaxation of the SMAS- platysma complex, excess submental adipose tissue, loss of skin elasticity, and anatomic factors such as hyoid position. Patients with heavy tissues in the neck area are more likely to have disappointing or short-lived results from neck rejuvenation surgery. Placement of an expanded-polytetrafluoroethylene (Gore-Tex) cervical sling provides additional support to the soft tissues of the neck, improving both initial and long-term cervical contours. This method is used in our practice for most patients with heavy neck tissues undergoing lower facial rejuvenation procedures. The cervical sling is well tolerated and provides the additional benefit of easy adjustability should the soft tissues of the neck further relax.

Impact of laryngeal paralysis and its treatment on the glottic aperture and upper airway flow characteristics during exercise.

Patients with unilateral vocal fold paralysis occasionally report shortness of breath during exercise. This symptom may persist in some patients after medialization thyroplasty. A review of the literature revealed no study that objectively evaluated laryngeal dynamics or airway flow characteristics during exercise after medialization thyroplasty for unilateral laryngeal paralysis. This study evaluates glottic aperture size and configuration as well as upper airway flow characteristics during exercise in 16 subjects. Six patients who underwent medialization thyroplasty for unilateral vocal fold paralysis were compared with 10 healthy control subjects. During a standardized exercise protocol on an incremental ergometer (bicycle type), real-time videolaryngoscopy was obtained and correlated in a synchronized fashion with maximum-effort respiratory efforts at the beginning, midpoint, and end of the exercise period. Direct calculations of glottic size during various phases of the exercise period were performed from digitized images. These data were correlated with inspiratory flow data for each patient. Patients with laryngeal paralysis demonstrated smaller mean glottic areas and lower peak inspiratory flow rates than controls both at rest and during all phases of the exercise period. This study suggests that after treatment of unilateral laryngeal paralysis with medialization thyroplasty, inspiratory flow rate and glottic area are significantly less than in normal controls.

Architectural deficiencies of the nose: treatment of the saddle nose and short nose deformities.

The saddle nose and short nose deformities are challenging surgical problems characterized by significant architectural deficiencies of the nasal framework. These defects produce cosmetic and functional nasal problems. Reconstructive techniques and augmentation materials are reviewed. Case examples illustrate the authors currently preferred techniques.

Laryngeal motion during exercise.

OBJECTIVE: To compare laryngoscopically observed changes in the larynx during exercise in persons with exercise-induced laryngomalacia (EIL) with changes in asymptomatic control subjects. STUDY DESIGN: Clinical study using a standardized exercise protocol. METHODS: Subjects exercised on an incremental ergometer: videotaped recordings of the larynx were obtained through the entire exercise; pulmonary function tests were completed before and/or immediately after the exercise. RESULTS: Laryngeal lumen size decreases during exercise in subjects with EIL. CONCLUSION: Subjects with EIL had a significant decrease in laryngeal lumen size during exercise compared with asymptomatic control subjects.

Risk factors for malignancy in adult tonsils.

BACKGROUND: Tonsillectomy in adults (age 18 years and older) is performed for a variety of conditions. The palatine tonsils may harbor carcinoma or lymphoma, and this potentially unanticipated finding may follow routine tonsillectomy in the adult. The ability to preoperatively identify adult tonsillectomy patients at increased risk for tonsillar malignancy could sensitize the clinician to this possibility and the potential need for expedited rather than routine tonsillectomy scheduling. METHODS: A retrospective review of 476 consecutive adult patients who underwent tonsillectomy during the last 10 years at the University of Iowa Hospitals and Clinics was undertaken. Proposed risk factors for tonsillar malignancy included a prior history of head and neck cancer, tonsillar asymmetry, palpable firmness or visible lesion in the tonsil, neck mass, unexplained weight loss, and unexplained constitutional symptoms. These risk factors were correlated with the pathologic diagnosis in the reviewed cases. RESULTS: Of these 476 patients, 25 had malignant tonsil pathology. No patient without risk factors was found to have malignancy on pathologic evaluation of the tonsils. Of the 25 patients with malignant tonsillar pathology, 23 had two or more risk factors, and 2 patients had one risk factor. Tonsillar asymmetry, found in 20 of the 25 cases, was the risk factor most frequently associated with malignant pathology. CONCLUSIONS: These results indicate that the presence of certain preoperatively identifiable risk factors are associated with the pathologic finding of malignancy in adult tonsillectomy specimens. Based on these criteria, a model which is predictive of the presence of tonsil malignancy may be constructed.

Influence of dietary calcium and vitamin D on colon epithelial cell proliferation and 1,2-dimethylhydrazine-induced colon carcinogenesis in rats fed high fat diets.

We investigated whether increased levels of dietary calcium and vitamin D could inhibit colon carcinogenesis in rats injected with a single dose of 1,2-dimethylhydrazine. Rats were given a single subcutaneous injection (200 mg/kg body wt) 2 wk before they were fed purified diets containing 20% fat for 32 wk. Diets contained one of three levels of calcium (5, 10 or 15 g/kg diet) as calcium gluconate and one of three levels of vitamin D (0.025, 0.05 or 0.1 mg/kg diet) as cholecalciferol in a 3 x 3 factorial design. Rats receiving the highest level of vitamin D had greater plasma concentrations of 25-hydroxy-vitamin D. Autoradiographic examination of [3H]thymidine-treated rats demonstrated that a higher dietary level of calcium as well as higher levels of vitamin D significantly affected cellular kinetic indices. The total tumor incidence and tumor incidence in the distal colon was 45% lower in rats fed the highest level of both calcium and vitamin D compared with the other eight groups, although this decrease was not statistically significant (P = 0.12). The possible importance of these observations is discussed.

Effect of dietary vitamin E on the development of altered hepatic foci and hepatic tumors induced by the peroxisome proliferator ciprofibrate.

The purpose of this study was to determine the effect of the dietary antioxidant vitamin E on hepatocarcinogenesis by peroxisome proliferators which, it is hypothesized, induce tumors by increased production of hydrogen peroxide or other oxygen radicals. Rats were fed diets containing the peroxisome proliferator ciprofibrate and one of three concentrations (10, 50, or 500 ppm) of alpha-tocopheryl acetate for 6 months or 21 months. The incidence of hepatic tumors and the number and volume of gamma-glutamyl-transpeptidase-positive, ATPase-negative, glucose-6-phosphatase-negative, and glucose-6-phosphatase-positive foci were quantified. No tumors or altered hepatic foci were seen at 6 months, but at 21 months the incidence of hepatic tumors and the number and volume of altered hepatic foci were increased in rats fed higher levels of vitamin E. Indices of oxidative damage--concentrations of malonaldehyde, conjugated dienes, and lipid-soluble fluorescence products--were not affected or were lower in rats fed higher amounts of vitamin E; the enhancing effect of vitamin E on the development of altered hepatic foci and hepatic tumors, therefore, was not related to the induction of cellular oxidative damage. Hepatic peroxisomal fatty acid beta-oxidation and vitamin C concentrations were not affected by vitamin E, whereas the glutathione concentration was decreased in rats fed higher amounts of vitamin E. This study shows that increasing the vitamin E content of the diet enhances ciprofibrate-induced hepatocarcinogenesis, but the mechanism of this effect is unclear.

Effect of dietary selenium on the induction of altered hepatic foci and hepatic tumors by the peroxisome proliferator ciprofibrate.

The purpose of this study was to determine if the dietary antioxidant selenium could inhibit hepatocarcinogenesis induced by peroxisome proliferators, which are hypothesized to induce tumors by increased production of hydrogen peroxide or other reactive oxygen species. Rats were fed diets containing the peroxisome proliferator ciprofibrate and one of three concentrations (0.04, 0.2, or 1.0 ppm) of selenium for 6 or 21 months. The incidence of hepatic tumors and the number and volume of gamma-glutamyl transpeptidase-positive, ATPase-negative, glucose-6-phosphatase-negative, and glucose-6-phosphatase-positive foci at 21 months were lower in rats fed higher levels of selenium (no foci or tumors were seen at 6 mo). Indices of oxidative damage in the liver (thiobarbituric acid reactants, conjugated dienes, and lipid-soluble fluorescence products), however, were not decreased in rats fed the high-selenium diet. Therefore, selenium was protective against ciprofibrate-induced hepatocarcinogenesis, but not by reducing the degree of oxidative damage. The liver selenium and glutathione concentrations, and liver selenium-dependent glutathione peroxidase activity, increased as dietary selenium increased. Therefore, inhibition of carcinogenesis by selenium was correlated with increased levels of glutathione and glutathione peroxidase, but these did not inhibit the indices of oxidative damage. Peroxisomal beta-oxidation also increased with the dietary selenium content; it therefore does not appear to be a factor in the inhibition of hepatocarcinogenesis in rats fed higher levels of selenium.