The Blood Supply of the Human Velum and Pharynx: Some Implications for Cleft Palate Surgery

This thesis has described in detail the blood supply of the soft palate and posterior pharyngeal wall in a series of dissections performed on human fetuses and cadavers. A variety of injection media were used in both fresh and fixed specimens to demonstrate the vascular anatomy. Adult cadavers were dissected by conventional methods. For the fetuses a dissection microscope and microsurgical instruments were required. Radiology and clearing techniques have also been used. It was found that three arteries are important in the supply of the normal soft palate - the ascending palatine, ascending pharyngeal and accessory meningeal arteries. The posterior pharyngeal wall was normally supplied by branches of the ascending pharyngeal and superior thyroid arteries. A small series of dissections has also been carried out on fetuses with cleft palate and the vascular anatomy shown to be similar to normal cases with some minor variations. This finding was confirmed by histological studies performed on several fetal heads. Detailed findings have been given of the blood supply of the velar muscles, in particular levator veli palatini and tensor veli palatini. Both these muscles were normally shown to have a dual arterial supply. The most common pattern observed was the levator receiving branches from the ascending palatine and ascending pharyngeal vessels and the tensor from the ascending palatine and accessory meningeal. Several velar muscles were also examined histochemically in a number of fresh specimens both to study the intramuscular vascular anatomy and to identify fibre types. In no case of levator was any large vessel seen entering the upper lateral portion of the muscle. In each muscle both type I and type IIb fibres were identified, with the levator appearing to have the highest proportion of fast twitch IIb fibres. The anatomical observations made have been related to cleft palate surgery including pharyngoplasty. It was observed that of different types of pharyngoplasty performed, laterally based flaps appeared to have the richest blood supply. The finding of dual blood supply of the levator and tensor veli palatini suggests that if careful cleft palate closure is performed these muscles should not suffer ischaemic damage. On the other hand, anatomical observations together with skull measurements made on a series of child and adult skulls point to the possibility that two manoeuvres commonly performed in cleft closure could be damaging to the levator and render a portion of it ischaemic: these are intravelar veloplasty and dissection posterior to the maxillary tuberosity. The author believes that extensive intravelar veloplasty, especially if carried out together with a deep lateral dissection behind the maxillary tuberosity, should be avoided. Dissection and histological findings in fetuses with cleft palates also showed that the levator has a tripartite insertion: into the cleft soft palate edge, the tensor tendon or aponeurosis, and the posterior aspect of the hard palatal shelf. Extensive intravelar veloplasty is often therefore not required on anatomical grounds as many of the fibres run in a normal direction. On the basis of observations made, a sequential series of steps is suggested for cleft palate closure in order to minimise risk of vascular damage to the palatal muscles

The Community Arts Council Movement: History, Opinions, Issues

Initially published in 1982, this book serves as an historical survey of the community arts council movement, as well as an analysis of programs, practices, and trends. Research for the book includes analysis of original source documents from arts councils, as well as discussions with more than 100 members and leaders of arts councils nationwide, including leaders of the National Endowment of the Arts and the American Arts Alliance. Original publication date 1982.https://engagedscholarship.csuohio.edu/clevmembks/1046/thumbnail.jp

5-Hy­droxy-3-methyl-5-phenyl-4,5-di­hydro-1H-pyrazole-1-carbothio­amide

In the title compound C11H13N3OS, the aromatic ring and the dihydro­pyrazole ring are oriented orthogonally with respect to each other, making a dihedral angle of 89.92 (9)°. An intra­molecular O—H⋯S hydrogen bond occurs. In the crystal, weak N—H⋯N and N—H⋯S hydrogen bonds link the mol­ecules into a columnar stack propagating along the b axis

Understanding Antipsychotic Drug Use in the Nursing Home Setting

Introduction: The increasing prevalence of antipsychotic medication use in residents of nursing homes (NH) in the absence of psychiatric diagnoses is concerning. To address these concerns, it is essential to explore how these medications are being prescribed and managed in the NH setting. Our objectives were to understand the decision-making process that influences prescribing and factors that trigger administration of antipsychotic medications to residents with dementia in NHs and to explore why residents remain on antipsychotic medications over an extended period of time. Methods: Interviews with prescribers, caregivers, and family members, on-site observations in study facilities, and review of NH resident medical records. Facilities were selected to obtain a diverse sample of NHs. Results: 204 NH residents with dementia in 26 facilities distributed across five selected Centers for Medicaid and Medicare Services regions were included. Problematic behaviors were the dominant reasons offered as influencing prescribing of antipsychotic medications. Providers indicated that they chose an antipsychotic, rather than another drug class, because they believed that antipsychotic medications were more likely to be effective. There was no standard approach to taper attempts. Family members identified a lack of communication as a barrier to their involvement in decision-making. Conclusions: There is widespread perception that antipsychotic medications are effective and beneficial in managing problematic behaviors in NH residents with dementia. Little attention is given to planning for antipsychotic tapering or discontinuation. There may be opportunities to involve family members more fully in decision-making around the use of antipsychotic medications

The response of the host microcirculation to bacterial sepsis: Does the pathogen matter?

Sepsis results from the interaction between a host and an invading pathogen. The microcirculatory dysfunction is now considered central in the development of the often deadly multiple organ dysfunction syndrome in septic shock patients. The microcirculatory flow shutdown and flow shunting leading to oxygen demand and supply mismatch at the cellular level and the local activation of inflammatory pathways resulting from the leukocyte-endothelium interactions are both features of the sepsis-induced microcirculatory dysfunction. Although the host response through the inflammatory and immunologic response appears to be critical, there are also evidences that Gram-positive and Gram-negative bacteria can exert different effects at the microcirculatory level. In this review we discuss available data on the potential bacterial-specific microcirculatory alterations observed during sepsis

Phase II evaluation of MGBG in non-small cell carcinoma of the lung

One hundred and eight patients with non-small cell lung cancer were treated in a Phase II trial with MGBG at a dose of 600 mg/m 2 i.v. weekly. Partial responses were noted in 3/43 patients with adenocarcinoma and 1/40 with squamous cell carcinoma. No responses were noted in 24 patients with large cell carcinoma. Overall, the drug was reasonably well-tolerated. At this dosage and schedule, MGBG has no substantial antitumor activity for patients with non-small cell lung cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45128/1/10637_2004_Article_BF00180196.pd