Medial pancreatectomy

The surgical treatment of benign tumors of the midportion of the pancreas usually consists of enucleation or formal pancreatectomy. To avoid extended pancreatectomy, a limited resection of the neck of the pancreas has been proposed when enucleation is not feasible. Seven published series report a total number of 78 patients treated by this technique. No postoperative mortality was reported. The operative morbidity ranged from 0% to 40%, mainly due to pancreatic fistulas, which mostly healed spontaneously. In the long term no diabetes mellitus and/or exocrine insufficiency was observed. After resection of low-grade malignant tumors, there was no local recurrence. Medial pancreatectomy is a safe method for the treatment of benign or low-grade malignant tumors of the neck of the pancreas. Received: July 3, 2000 / Accepted: August 8, 2000     

中段胰腺切除术

Medial pancreatectomy has been gradually used in the treatment of benign tumors in neck and body of pancreas since less removal of the pancreas and the retainment of the duodenum,spleen and functional pancreas,it is less harmful to the endocrine and exocrine function of the patients.Seventeen patients received medial pancreatectomy for benign tumors in neck and body of the pancreas in the China-Japan Union Hospital of Jilin University from November 2005 to December 2010.Fifteen patients received the closure of broken ends of pancreatic head,pancreaticojejunostomy,and the other 2 received pancreaticojejunostomy.No perioperative death was found.All the patients were followed up for 2 to 45 months,and no death was recorded.No patient got new-onset diabetes and pancreatic pseudocyst,and their tumors were not relapsed.Now the retrospective analysis was carried out to this group of patients and to further regulate the surgical operation of the medial pancreatectomy.     

Medial epicondylectomy

Cubital tunnel syndrome is a common but complicated ulnar neuropathy that needs to be carefully evaluated and classified before developing a cohesive plan of attack. In situ decompression/with medial epicondylectomy (ISD/ME) can be a viable treatment option for all preoperative grades of cubital tunnel syndrome, but may not necessarily be the treatment of choice, based on information gathered from the patient's preoperative evaluation. We outline a comprehensive list of indications for treatment of cubital tunnel syndrome by ISD/ME. If one adheres to these indications, and abides by the technique of a partial medial epicondylar excision, as advocated by O'Driscoll, Amako, and others, the results indicate that patients should have an acceptable outcome.     

Medial epicondylitis

Medial epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the medial epicondyle. Although commonly referred to as "golfer's elbow", the condition may in fact be caused by a variety of sports and occupational activities. Accurate diagnosis requires a thorough understanding of the anatomic, epidemiologic, and pathophysiologic factors. Nonoperative treatment involves rest, ice, nonsteroidal anti-inflammatory agents, and possibly corticosteroid injection followed by guided rehabilitation and return to sport. Operative treatment is indicated for debilitating pain after exclusion of other pathologic causes that persists in spite of a well-managed nonoperative regimen spanning a minimum of 6 months. The surgical technique involves excision of the pathologic portion of the tendon, repair of the resulting defect, and reattachment of the origin of the flexor pronator muscle group to the medial epicondyle. Surgical treatment results in a high degree of subjective relief, although objective strength deficits may persist.     

中段胰腺切除术

中段胰腺切除术因切除的胰腺组织少,保留了十二指肠、脾脏和有功能的胰腺,对患者内外分泌功能影响较小,近年来逐渐被应用于胰腺颈体部良性肿瘤的治疗。本文回顾性分析2005年11月至2010年12月我院接受中段胰腺切除术的17例胰腺颈体部良性肿瘤患者的临床资料,探讨中段胰腺切除术的技术要点。     

Medial column stabilization

This article presented a brief review of medial column stabilizing procedures. The various types of procedures that have been advocated for different deformities have been discussed. It is important to keep in mind that fusion of any of the medial column joints should not be performed as an isolated procedure in flexible flatfoot deformity. Medial column stabilization is only a component procedure when surgically managing a flexible flatfoot. When choosing procedures to correct a flexible flatfoot, thorough preoperative evaluation is important. It is also important to realize that conservative measures should be exhausted before attempting any type of stabilization of the medial column for flexible flatfoot deformity. Specific criteria for flexible flatfoot surgery should include severe uncontrollable deformity, an inability to wear standard foot gear, and persistent pain and disability despite exhaustive conservative therapy. A medial column stabilization is also an excellent procedure for those patients who have end-stage degenerative joint disease of the medial longitudinal arch.     

Medial subtalar dislocation

We report a medial subtalar dislocation without fracture in an eighteen year old male injured during basketball game. He was succesfully treated with closed reduction and cast immobilization. At one year follow-up he was symptomless.

---

Résumé  Nous rapportons une luxation sous-astragalienne interne sans fracture, survenue au cours d’un jeu de basket-ball chez un homme de 18 ans. Il a été traité avec succès par réduction fermeé et immobilisation platreée. Au délais d’un an, il était asymptomatique.

---

---

Accepted: 24 August 1999     

Medial peritalar dislocation

In this paper, a case of closed medial subtalar dislocation and accompanying talar head fracture in a 22-year-old man which occurred while walking on a downhill road is reported. Closed reduction under general anesthesia was unsuccessful. The obstacle for closed reduction was determined at surgery for open reduction and internal fixation as buttonholing of the talar head through the extensor retinaculum. At the 26-month follow-up, he was pain-free in his daily activities.     

Medial thigh lift

Medial thigh ptosis, characterized by rhytidosis and seen commonly from aging and great weight loss, is seldom improved by lateral or posterior thigh lift. A simple procedure has been developed to correct this laxity of the upper, inner thighs. This consists of symmetrical resection of a crescent-shaped segment of skin and subcutaneous tissue having the distribution of an L1 embryological dermatome, just inferior to the inguinal crease. Despite temporary sensory loss and spreading of scars in some patients, the procedure has been gratifying to both patient and surgeon. Patients must be carefully selected, as the procedure does not correct either trochanteric lipodystrophy or ptosis, or lipodystrophy medial to and just superior to the knee.     

Medial ankle instability

Medial instability is suspected on the basis of a patient's ankle feeling like it is "giving way," especially medially, when walking on uneven ground, downhill, or down stairs, pain at the anteromedial aspect of the ankle, and sometimes pain in the lateral ankle, especially during dorsiflexion of the foot. A history of a chronically unstable feeling that is manifested by recurrent injuries with pain, tenderness, and sometimes bruising over the medial and lateral ligaments, is considered to indicate combined medial and lateral instability that is believed to result in rotational instability of the talus in the ankle mortise. Pain on the medial gutter of the ankle and a valgus and pronation deformity of the foot are hallmarks of the disorder. The deformity typically can be corrected by the activation of the posterior tibial muscle. In contrast to stress radiographs, arthroscopy is a helpful diagnostic tool in verifying medial instability; it proved that the lateral ankle ligaments also can be involved. The treatment for symptomatic medial instability of the ankle might include reconstruction of all involved ligaments at the medial, and, if necessary, the lateral ankle. In the case of progressed foot deformity or bilateral long-standing valgus and pronation deformity of the foot, an additional calcaneal lengthening osteotomy might be considered. A classification of the instability into three types has been helpful for determining surgical treatment and the after treatment. This treatment concept provides high patient satisfaction and reliable clinical results.     

Micro-CT Density Analysis of the Medial Wall of the Human Medial Cuneiform

The human medial cuneiform is incompletely characterized with regard to anatomical morphology, including mineral density and bone quality. Clinically, we have observed failures of fixation by pull-through of devices through relatively soft medial bone. Defining patterns of relative density may provide valuable information regarding implant placement as higher cortical density bone may offer better resistance to such failures. We sought to identify an area of greatest density along the medial wall of the medial cuneiform.Ten fresh-frozen human cadaveric medial cuneiforms underwent micro-computed tomography imaging. Images were analyzed to obtain densities in 4 quadrants along the medial wall of the medial cuneiform. Seven of 10 specimens revealed a maximum density in the plantar distal quadrant of the medial wall of the medial cuneiform. Chi-square goodness-of-fit testing indicated that the density of this quadrant was significantly different from 3 other quadrants (P<.009). Using the Principle of Standard Residuals, the density of the plantar distal quadrant was significantly different than the other 3.We conclude that the plantar distal quadrant of the medial cuneiform contains bone of maximal density when compared to 3 other quadrants. Surgeons who place implants in this region should be aware that this area might offer better resistance to fixation failure.