Faculty Bibliography

The aim of this collaborative public health study was to engage families, agencies, and programs in reducing secondhand smoke exposure in Central Harlem, New York City. Baseline interviews (n=657) and focus groups (n=4) were conducted with adult members of households with children who had asthma and asthma-like symptoms in the Harlem Children's Zone Asthma Initiative. The interviews concerned the prevalence and determinants of exposure of enrolled children to secondhand smoke. Key findings were that participants: (1) were generally aware of the hazards of secondhand smoke; (2) used strategies to reduce exposure to secondhand smoke in their homes; (3) believed that outdoor pollutants are sometimes just as bad for the health of their children as secondhand smoke; and (4) used smoking to provide stress relief and help diffuse otherwise volatile situations in their homes. The Harlem Smoke-Free Home Campaign was launched in October 2007 based in part on these findings.

BACKGROUND: Widespread application of composite tissue allotransplantation has been impeded by risks of rejection and conventional immunosuppression. The authors have developed a nonhuman primate composite tissue allotransplantation model that demonstrated reliable and long-term success necessary to progress to preclinical studies. METHODS: Composite facial subunits (e.g., skin, muscle, and bone) were transplanted between mismatched cynomolgus monkeys. Vascular supply was based on the common carotid artery and external and internal jugular veins. Facial allografts were heterotopically transplanted to the recipient's lower abdomen with end-to-side anastomoses of the common carotid artery to the common femoral artery and of both the internal and external jugular veins to the common femoral vein. Animals received tacrolimus monotherapy. Grafts were inspected daily, submitted to biopsy regularly, and studied with magnetic resonance imaging. RESULTS: Thirteen transplants were performed. Two grafts based on the common carotid artery and only the internal jugular vein failed within 3 to 5 days because of venous thrombosis not related to rejection. Subsequent transplants included anastomoses of both the internal and external jugular veins to the common femoral vein without thromboses. Immunosuppression consisted of tacrolimus monotherapy and was tolerated without complications. Long-term success was achieved with rejection-free graft survival (60 to 177 days). CONCLUSIONS: The authors have developed the first successful model of facial composite tissue allotransplantation in a nonhuman primate. Technical requirements include preservation of both internal and external jugular venous outflow. Tacrolimus monotherapy permitted prolonged rejection-free graft survival without early complications. This model provides a platform for further investigation of composite tissue allotransplantation tolerance and requirements for indefinite survival.

BACKGROUND: Evaluation of long-term outcomes of free-muscle transfer for smile restoration is overdue. Arguments for and against free-muscle transplantation in children are considered, and the debate on the influence of the growing skeleton on muscle function is revisited. This study evaluated the fate of free-muscle transfer over long follow-up periods in pediatric patients. METHODS: Thirty-two children with follow-up of 5 years or longer who received a free-muscle transfer for smile restoration were reviewed. To better analyze the effect of time, patients were classified into groups based on the length of follow-up: group A, 5 to 6 years; group B, 7 to 10 years; group C, 11 to 15 years; and group D, more than 15 years. Patients were videotaped at three stages: preoperatively, 2 years after free-muscle transfer, and at the last follow-up visit. Four independent observers graded patients' videotapes using a five-category scale ranging from poor to excellent. Panelists were asked to comment on any noticeable craniofacial disharmony with growth. RESULTS: All patients exhibited improved function and symmetry at 2 years after free-muscle transfer (averaged scores, p < 0.0001). A positive effect of time was seen in the long-term evaluation; observers' scores (p < 0.0001) and motor units on electromyography (p = 0.001) showed further improvement. No significance was found when comparing measured outcomes among the four follow-up groups, indicating that despite the growing skeleton, muscle function was maintained over time. CONCLUSIONS: These clinical data support the use of free-muscle transfer for smile restoration in children. The transplanted muscle appears to grow harmoniously with the craniofacial skeleton, and muscle function and aesthetic outcomes improved over time

BACKGROUND: The versatility of the temporalis muscle justifies its wide popularity in reconstructive craniomaxillofacial surgery. In late facial paralysis, results of neural reconstructive techniques such as cross-facial grafting or mini-hypoglossal-to-facial nerve transfer are partial at best. In this series, the authors have used a segmental temporalis transfer, the 'mini-temporalis,' to augment the function attained with neural microsurgery. The aim of this present study was to present the experience of the authors' center with the use of the mini-temporalis as an adjuvant to facial nerve microsurgery for smile restoration. METHODS: Data were collected from 31 patients who underwent mini-temporalis transfer for smile restoration. In all patients, the mini-temporalis was used to augment the results of neural reconstructive techniques. Opting for the mini-temporalis related to a variety of reasons, after preoperative evaluation was weighed against the advantages and disadvantages of different reconstructive strategies on individual bases. Aesthetic and functional outcomes were evaluated by a panel of five independent observers using a five-category scale ranging from poor to excellent. RESULTS: All patients observed a follow-up longer than 3 months. Of 31 patients, 61.3 percent achieved excellent or good results and 29 percent achieved moderate results. All patients demonstrated an increase in the observers' scores after mini-temporalis transfer in comparison with the scores granted preoperatively or after neural microsurgery. Highly motivated patients committed to postoperative motor reeducation exhibited the best results. CONCLUSION: The clinical data presented support the use of mini-temporalis transposition in association with facial nerve microsurgery as a valuable alternative to free muscle transfer in selected cases

Background: Ectopic beats are frequently associated with morphologic repolarization alterations of ensuing sinus beats. Less is known about repolarization duration alterations of post-ectopic sinus beats. In one patient who developed long QT and torsades de pointes upon exposure to a class III antiarrhythmic drug, and was later genotyped as being a carrier for long QT syndrome (LQTS) type 1, review of a pre-drug Holter monitor study revealed marked QT prolongation of post-ectopic sinus beats. In wondering whether this might be a common clue to "concealed" unexpressed LQTS, we realized that we must first characterize the range of post-ectopic QT prolongation present in normals. Prolongation beyond the upper limit of this range might then raise suspicion of possible LQTS and alter the antiarrhythmic drug selection process for the suppression of atrial fibrillation or other arrhythmias. Methods: Accordingly, we assessed the presence/degree of repolarization prolongation following premature ectopic impulses in 166 subjects with normal conduction intervals and normal repolarization on their resting 12-lead ECG, 75 of whom had no known associated cardiovascular disorder of any kind. That is, in our subjects, the maximal prolongation of the QT interval of the sinus beat following isolated ventricular and atrial premature complexes was characterized. Results: QT prolongation is common in post ectopic sinus beats. However, in our subjects the uncorrected QT interval of post-ectopic sinus beats never exceeded 480 ms in duration [which was much shorter than that seen (510-590 ms) in our gene carrier]. CONCLUSIONS: The QT interval in normal subjects may prolong following premature complexes but not to a value in excess of 480 ms.