3400 Spruce St, 5 Ravdin
Philadelphia PA 19104
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: MD447387
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Lower Lid Malposition: Causes and Correction. - Facial plastic surgery clinics of North America
Lower lid malposition is a common yet demanding problem that both functional and cosmetic eyelid surgeons will face. It encompasses a spectrum of lower eyelid conditions ranging from lower lid retraction to frank ectropion and entropion. The causes of lower lid malposition are numerous, and the problem can be challenging to correct even for experienced surgeons. Proper treatment of lower lid malpositioning requires a clear understanding of the lower eyelid anatomy, careful preoperative assessment, and appropriate selection of surgical and nonsurgical interventions to have a successful outcome.Copyright Â© 2016 Elsevier Inc. All rights reserved.
Upper Lid Blepharoplasty. - Facial plastic surgery clinics of North America
Upper lid blepharoplasty is a common procedure for restoration and rejuvenation of the upper eyelids that can be performed safely and reliably. Understanding the anatomy and aging process of the brow-upper lid aesthetic unit along with properly assessing the excesses and deficiencies of the periorbital region helps to formulate an appropriate surgical plan. Volume deficiency in the aging upper lid may require corrective augmentation. Preexisting asymmetries and ptosis need to be identified and discussed before surgery. Standardized photography along with a candid discussion regarding patients' desired outcomes and realistic expectations are essential to a successful outcome.Copyright Â© 2016 Elsevier Inc. All rights reserved.
What are some tips and pearls for preserving and improving nasal function when performing a cosmetic rhinoplasty? - Current opinion in otolaryngology & head and neck surgery
Understanding nasal form and function is critical in performing successful cosmetic rhinoplasty. Careful evaluation of the patient's nasal airway with identification of areas of existing or potential obstruction is important in avoiding potential pitfalls that may compromise nasal function following rhinoplasty. This article will review surgical techniques that can be utilized to preserve and improve nasal function during cosmetic rhinoplasty.Recent literature on nasal functionality focuses on the management of the internal and external nasal valve as well as the nasal septum during rhinoplasty.Successful cosmetic rhinoplasty requires a thorough preoperative analysis of both aesthetic and functional characteristics of the nose. Close attention should be paid to the internal and external nasal valves and nasal septum before and during surgery to preserve and improve nasal function following cosmetic rhinoplasty.
A catecholamine-secreting skull base sinonasal paraganglioma presenting with labile hypertension in a patient with previously undiagnosed genetic mutation. - Journal of neurological surgery reports
Sinonasal paragangliomas are very uncommon neuroendocrine tumors that can present as skull base lesions. Functional paragangliomas are exceedingly rare. They can be associated with genetic mutations that have been associated with increased risk of head and neck paragangliomas. We present a case of a rare functioning sinonasal paraganglioma of the skull base in a patient with distant history of prior abdominal paragangliomas. The patient underwent subtotal endoscopic resection of the skull base lesion limited by carotid encasement of the tumor. They were treated with postoperative adjuvant radiation and therapeutic metaiodobenzylguanidine (MIBG) therapy. Genetic testing revealed succinate dehydrogenase B (SDHB) mutation. Skull base paragangliomas are rare tumors that may preclude complete surgical resection. (131)Iodine-MIBG can be used as adjuvant therapy in postoperative external beam radiation and in MIBG avid tumors. Long-term follow-up is needed given locally aggressive nature of these tumors, especially for patients with history of genetic mutations such as SDHB mutations as recurrent paragangliomas may develop.
Indications for external frontal sinus procedures for inflammatory sinus disease. - American journal of rhinology & allergy
In the modern age of endoscopic sinus surgery (ESS), there is an undefined role for external approaches in the treatment of inflammatory disease. This study examines the frontal sinus surgery practices of three experienced rhinologists with a focus on those who underwent an external approach. Our goal was to characterize these patients and propose indications for the use of an external approach alone or in combination with functional ESS (FESS) for frontal sinus inflammatory disease.A retrospective review was performed of frontal sinus procedures performed for inflammatory disease at one institution from 2004 to 2007.Seven hundred seventeen procedures were performed, 38 (5.3%) of which were external alone (14 procedures) or in combination with FESS (24 procedures). Osteoplastic flap with obliteration (12/14) made up the majority of external alone procedures and the most common indication was neo-osteogenesis of the frontal recess. Trephination was the most common external adjunct to FESS (12/24), and often was performed for type 3 frontal recess cells or in the initial management of acute frontal bone osteomyelitis (FOM). Twenty-eight of 38 (74%) patients had a history of previous surgery. Of the 10 patients with no history of previous surgery, 6 (60%) had an external adjunct for frontal recess neo-osteogenesis. There were no major complications but 9/38 (23.7%) patients required revision surgery for persistent/recurrent symptoms.External approaches alone and in combination with FESS are predominantly secondary to neo-osteogenesis of the frontal recess. Factors associated with neo-osteogenesis include previous trauma, endoscopic surgery, and FOM. External frontal sinus surgery provides adequate management of inflammatory disease but has a high revision rate.
Endoscopic repair of supraorbital ethmoid cerebrospinal fluid leaks. - ORL; journal for oto-rhino-laryngology and its related specialties
To examine the clinical and anatomical characteristics of patients with supraorbital ethmoid (SOE) cerebrospinal fluid (CSF) leaks and encephaloceles and identify specific considerations unique to their management.Retrospective review of patients who underwent repair of SOE CSF leaks at our institution from 2003 to 2007.The majority of patients were women (5/8), middle-aged (mean: 54.9 years) and had a high body mass index (mean 42.3). Intracranial pressures (ICPs) were elevated in 6/8 patients. Anatomically, 6/8 patients had defects medial to the medial orbital wall (MOW; mean distance: 4.15 mm) and 2/8 had defects lateral to the MOW (mean distance: 8.14 mm). Seven out of 8 were successfully repaired endoscopically, and 1 patient with a lateral defect required an adjunctive trephination.Patients with spontaneous SOE CSF leaks have unique clinical characteristics that include obesity and elevated ICP. Extension of a skull base defect lateral to the MOW and a narrow anterior-posterior diameter of the frontal recess are technical obstacles to endoscopic repair and may necessitate an adjunctive external approach.Copyright 2009 S. Karger AG, Basel.
Dynamic changes in conduction velocity and gap junction properties during development of pacing-induced heart failure. - American journal of physiology. Heart and circulatory physiology
End-stage heart failure (HF) is characterized by changes in conduction velocity (CV) that predispose to arrhythmias. Here, we investigate the time course of conduction changes with respect to alterations in connexin 43 (Cx43) properties and mechanical function during the development of HF. We perform high-resolution optical mapping in arterially perfused myocardial preparations from dogs subjected to 0, 3, 7, 14, and 21 days of rapid pacing to produce variable degrees of remodeling. CV is compared with an index of mechanical function [left ventricular end-diastolic pressure (LVEDP)] and with dynamic changes in the expression, distribution, and phosphorylation of Cx43. In contrast to repolarization, CV was preserved during early stages of remodeling (3 and 7 days) and significantly reduced at later stages, which were associated with marked increases in LVEDP. Measurements of differentially phosphorylated Cx43 isoforms revealed early, sustained downregulation of pan-Cx43 that preceded changes in CV and LVEDP, a gradual rise in a dephosphorylated Cx43 isoform to over twofold baseline levels in end-stage HF, and a late abrupt increase in pan-Cx43, but not dephosphorylated Cx43, lateralization. These data demonstrate that 1) CV slowing occurs only at advanced stages of remodeling, 2) total reduction of pan-Cx43 is an early event that precedes mechanical dysfunction and CV slowing, 3) changes in Cx43 phosphorylation are more closely associated with the onset of HF, and 4) Cx43 lateralization is a late event that coincides with marked CV reduction. These data reveal a novel paradigm of remodeling based on the timing of conduction abnormalities relative to changes in Cx43 isoforms and mechanical dysfunction.
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3401 Civic Ctr Blvd Children's Hsptl Of Philadelphia - Emergency Med
3401 Civic Ctr Blvd Children's Hospital Of Philadelphia - Cardiology
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34Th & Civic Ctr Blvd Children's Hospital Of Philadelphia
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3400 Spruce St 1 Maloney Building
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