下蒂法乳房缩小整形术设计的改良应用

目的:探索一种简单易行的下蒂法乳房缩小整形手术的设计方法。方法:采用与Cohen类似的方法,术前设计进行了改良,采用乳房手术设计器结合改良设计方法做完善的术前设计,确定切口位置、新乳头的大小及位置,避免术中随意更改。结果:自2002年8月起,共行14例,经术后3～18个月随访,无明显并发症,新乳房形态自然,乳头乳晕感觉正常。结论:采用乳房手术设计器辅助设计的下蒂法乳房缩小整形术,手术设计简单、可灵活变化,手术安全、效果可靠。     

Robotic-Assisted Minimally Invasive Central Pancreatectomy: Technique and Outcomes

Background

Central pancreatectomy is a definitive treatment for low-grade tumors of the pancreatic neck that preserves pancreatic and splenic function at the potential expense of postoperative pancreatic fistula. We analyzed outcomes after robot-assisted central pancreatectomy (RACP) to reexamine the risk–benefit profile in the era of minimally invasive surgery.

Methods

Retrospective analysis of nine RACP performed between August 2009 through June 2010 at a single institution.

Results

The average age of the cohort was 64 (range 18–75 years) with six women (67 %). Indications for surgery included: five benign cystic neoplasm and four pancreatic neuroendocrine tumor. Median operative time was 425 min (range 305–506 min) with 190 ml median blood loss (range 50–350 ml) and one conversion to open due to poor visualization. Median tumor size was 3.0 cm (range 1.9–6.0 cm); all patients achieved R0 status. Pancreaticogastrostomy was performed in seven cases and pancreaticojejunostomy in two. The median length of hospital stay was 10 days (range 7–19). Two clinically significant pancreatic fistulae occurred with one requiring percutaneous drainage. No patients exhibited worsening diabetes or exocrine insufficiency at the 30-day postoperative visit.

Conclusions

RACP can be performed with safety and oncologic outcomes equivalent to published open series. Although the rate of pancreatic fistula was high, only 22 % had clinically significant events, and none developed worsening pancreatic endocrine or exocrine dysfunction.     

横双蒂加中央蒂真皮帽乳房缩小成形术

目的　介绍横双蒂加中央蒂真皮帽乳房缩小成形术的方法,并探讨其疗效。　方法　对8例(16只)乳房肥大病人施行手术治疗, 采用以乳头为中心的中央蒂真皮帽乳房缩小成形术, 设计双同心圆切口, 保留第4肋间神经径路乳腺组织的完整性, 切除多余乳腺组织, 环形切口缩拢缝合。结果　本组单侧切除组织量平均为(310±150)g,术后第2d查乳头乳晕感觉良好,反射存在,乳头乳晕无坏死,除1例伤口裂开行2期缝合外,余均无感染、血肿等并发症。随访6 (3 ~9)个月,外形满意,切口瘢痕不明显。　结论　横双蒂加中央蒂真皮帽乳房缩小成形术设计合理,形态好,可确保乳头乳晕的感觉及功能。     

Low-Cost Intra-Articular Distraction Technique Using Kirschner Wires and a Toothed Lamina Spreader

We describe a low-cost (instrument cost) technique for joint distraction using 2 Kirschner wires and a toothed lamina spreader in lieu of a Hintermann distractor. The described technique allows for temporary intra-articular distraction and visualization and preservation of the articular surface with extra-articular instrumentation. The technique can also allow for closed reduction and percutaneous treatment in cases of soft tissue compromise. Additionally, the technique uses common orthopedic surgical instruments, leading to a minimal learning curve for novice surgeons. We have found this distraction technique to be most effective for intra-articular preparation of hindfoot and midfoot arthrodeses and for navicular fracture reduction.     

Central core reduction mammoplasties and Marlex suspension of breast tissue

The author describes a technique for central core reduction mammoplasty with the same technique being utilized for a mastopexy. By transposition of the nipple areolar complex, the nerve supply as well as the vascular supply is maintained on an inferiorly based dermal pedicle. This technique does not require the recall of a multitude of points or locations or other maneuvers necessary to do the markings to obtain a symmetric, aesthetically pleasing reduction. The author has also developed a technique for the use of Marlex Mesh to support the remaining breast tissue and, by attaching the mesh to the area of the second rib, the support of the breast tissue is converted from cutaneous origin to skeletal origin, giving an internal support of breast tissue and preventing subsequent early ptosis and loss in fullness of the upper portion of the breast. The mesh has been used in 43 patients over the past two years with no serious complications.     

Optimized Technique in Needle Biopsy Protocol Shown to Be of Greater Sensitivity and Accuracy Compared to Wedge Biopsy

Background

Kidney biopsy is an important tool in determining allograft suitability for transplantation. Most deceased-donor renal biopsies performed today in the United States are wedge biopsies (WBs), with core needle biopsies being performed only by a minority of organ procurement organizations (OPOs). The lack of a gold standard in tissue sampling and tissue evaluation has prompted our OPO to find a more sensitive biopsy method as well as a more accurate pathology evaluation protocol to reassess expanded-criteria donor kidneys.

Methods

Between the months of March 2007 and June 2008, the New York Organ Donor Network OPO imported 226 kidneys. These kidneys had been previously biopsied by the originating OPOs utilizing the WB method. All 226 kidneys were rebiopsied by our preservation team using the optimized needle biopsy technique (ONBT) and then evaluated by the pathologists of the Transplant Pathology Laboratory of the Mount Sinai Hospital.

Results

Histologic findings from both types of biopsies were compared in the following parameters: glomerular yield, percentage of obsolete glomeruli, tubular interstitial scarring, arterial intimal fibrosis and acute tubular necrosis. Difference in glomerular yield between WB and ONBT was not statistically significant (P = .1736). ONBT detected more tubular interstitial scarring and arterial intimal fibrous narrowing than WB (P = .00). No statistical difference was found between the two biopsy methods in identifying acute tubular necrosis.

Conclusion

The data suggest that there were no statistical differences in sample reliability between ONBT and WB. However, ONBT was found to be significantly more sensitive in identifying allograft tubular interstitial scarring as well as intimal fibrous narrowing. Overall this study provides proof that ONBT is a more reliable and accurate method compared to WB in identifying important parameters of renal allograft.     

“L” Technique compared with others in mammaplasty reduction

With more than 20 years' experience with using my L method in reduction mammaplasty, I realize that very little has changed in my philosophy. With the L technique one can achieve a perfect shape with a minimal scar and avoid a medial scar toward the sternum. I use only the lower access with upper vascular protection, abandoning the inferior vascular base of the flap. This procedure has new competition including techniques that yield a simple vertical scar or only a periareolar scar. However, up to now it is not possible, with any technique, to achieve a satisfactory shape for exigent patients. When I explain to potential patients the advantages and disadvantages of the different methods, in most cases they choose the L technique.     

Wedge resection for lung cancer

The role of wedge resection in lung cancer is reviewed. In the past century, many reports appeared dealing with limited resection for lung cancer, and it is clear that wedge resection should be performed in patients who are considered at high risk for not tolerating lobectomy; still there is no prospective or even retrospective study on wedge resection carried out in candidates for lobectomy. In recent years, progress in imaging diagnostic technology using high-resolution computed tomography has increased the opportunity to diagnose early adenocarcinoma presenting as small ground-glass opacity (GGO) which could not be detected on chest radiographs. Some patients with GGO may become candidates for wedge resection in this century, if additional favorable data result from prospective studies relevant to imaging diagnosis, pathology, and prognosis.     

无神经损伤的胸腰椎骨折体位复位、塑形背托及早期活动处理的疗效

目的　报告 2 8例无神经损伤的、胸腰椎楔形压缩型及爆裂型骨折 ,用体位复位方法治疗的疗效。方法　对这类病人进行回顾性研究 ,观察项目包括 :工作能力、整体满意程度、疼痛程度、功能性结果及X线检查。结果　 90 %的病人经治疗后完全无痛或仅有微痛。 75 %的病人能恢复工作 ,其中包括全部楔形压缩型骨折的病人和 6 5 %的爆裂骨折病人。 90 %的病人日常生活仅受到极小的影响。结论　虽然所采用的体位复位方法及治疗步骤不能长期矫正脊柱后凸畸形 ,但整体的临床效果还是令人鼓舞 ,病人满意程度也很高。     

Central Compartment Neck Dissection for Thyroid Cancer: A Surgical Technique

Several professional societies have in the past few years joined forces to standardize and define terminology for central compartment neck dissection, with the objective of improving communication among professionals and encouraging a more uniform surgical approach to neck nodes. Precisely defining and describing a technique has the advantage of providing a basis for communication and for discussion. A basic technique should be reproducible with low morbidity and teachable to surgeons in training. We herein describe a basic technique for bilateral central compartment neck dissection for thyroid cancer.     

Comparison of Lateral Opening Wedge Calcaneal Osteotomy and Medial Calcaneal Sliding-opening Wedge Cuboid-closing Wedge Cuneiform Osteotomy for Correction of Planovalgus Foot Deformity in Children

The purpose of the present study was to compare the clinical and radiographic results between 2 procedures, lateral opening wedge calcaneal osteotomy (LCL) and medial calcaneal sliding-opening wedge cuboid-closing wedge cuneiform osteotomy (3C) in patients with planovalgus foot deformity. A total of 38 patients who underwent either LCL (18 patients, 28 feet) or 3C (20 patients, 32 feet) were included in the present study. The etiology of the planovalgus foot deformity was idiopathic in 16 feet and cerebral palsy in 44 feet. The 2 procedures used in the present study were indicated in symptomatic (pain or callus) children in whom conservative treatment, such as shoe modifications or orthotics, had been applied for more than 1 year but had failed. The patients were evaluated preoperatively, postoperatively, and at the last follow-up visit, both clinically and radiologically, and the interval to union and postoperative courses were compared between the 2 groups. In the LCL group, 19 of the 28 feet (68%) showed a satisfactory outcome and 9 (32%) an unsatisfactory outcome. In the 3C group, 28 of the 32 feet (88%) showed a satisfactory outcome and 4 (12%) an unsatisfactory outcome. The clinical results were not significantly different between the 2 groups, with mild to moderate pes planovalgus deformity. However, the clinical results were better in the 3C group with severe pes planovalgus deformity than in the LCL group with severe pes planovalgus deformity. All 4 radiographic parameters were improved at the last follow-up visit in both groups. In particular, the talar–first metatarsal angle and the calcaneal pitch angle on the weightbearing lateral radiographs were significantly improved in the 3C group with mild to moderate planovalgus foot deformity. All 4 parameters were significantly improved in the 3C group with severe planovalgus foot deformity. No significant differences were observed between the 2 groups in terms of the interval to union and postoperative care. No case of postoperative deep infection or nonunion was encountered in either group. 3C is a more effective procedure than LCL for the correction of pes planovalgus deformity in children, especially severe pes planovalgus deformities.