Breast augmentation with silicone implants: the role of surgical drainage—report on 502 consecutive patients

Breast augmentation is one of the most frequently performed cosmetic surgery procedures worldwide. We report on a series of 502 consecutive cosmetic breast augmentations by a single surgeon, using both the submuscular and submammary approaches. A vacuum drain was placed in the surgical pocket at the end of the procedure. The drain fluid collection was recorded immediately after the surgery and the following day before removal. A tenfold increase in the amount of fluid collection was noted in the drain’s reservoir. Thirteen patients presented with minor wound healing problems at the second postoperative follow-up, which were treated conservatively; two of them had the implant removed and replaced after 2 months. There were only two capsular contractions at 1-year follow-up. We focus our discussion on the drainage in the early postoperative period and conclude that the routine use of a surgical drainage reduces the risk for complications. Based on our findings, we advocate that short-term routine use of a surgical drain is advisable.     

CO2 laser in cancer surgery of the breast: a comparative clinical study

Review of the literature reveals little to no data regarding the use of the CO2 laser as a surgical modality in the local treatment of breast cancer. This study was undertaken to determine if the CO2 laser is a surgical improvement over the scalpel, influencing patient care during the surgical and postsurgical period. In the author's series, a total of 209 procedures were performed. Within this group, 105 cases were performed with CO2 laser and 104 cases performed with the scalpel. Biopsies were always performed as a separate procedure prior to definitive surgery. This study was not designed to compare cure rates, the medical follow-up period being 1 year. The results of this study demonstrate a significant improvement in patients' postoperative care, surgical technique, and hospital cost-effectiveness.     

Treatment of iatrogenic biliary obstruction by balloon dilatation of a biliary jejunal fistula

Biliary obstruction and multiple hepatic abscesses occurred in a patient after ligation of a segmental branch of the right hepatic duct. The patient was successfully managed by transhepatic biliary drainage and balloon dilatation of an internal fistula that developed between the ligated duct and a Roux limb of jejunum. Internal biliary fistulas may be dilated using interventioanl radiologic techniques to permit nonobstructed bile flow. Implications for the nonsurgical treatment' of biliary strictures are discussed.     

肱骨近端骨折手术与非手术治疗方法疗效分析

目的分析肱骨近端骨折手术及非手术治疗方法的疗效。方法2002～2003年对43例肱骨近端骨折分别采用切开复位解剖钢板、拉力螺钉、克氏针固定及手法复位夹板固定治疗。采用Constant-murley评分方法评定疗效。结果所有患者随访10～19个月,平均11.5个月。24例手术患者中优11例,良8例,可4例,差1例,优良率为79.2%;19例非手术患者中优6例,良7例,可6例,优良率为68.4%;手术疗效明显优于非手术疗效,差异有显著性意义(P<0.05)。X线片示无骨折不愈合及肱骨头坏死发生。结论对Neer分型中Ⅰ型和Ⅱ型中部分患者应采用非手术手法复位夹板固定治疗。而Ⅲ、Ⅳ型应采用手术方法治疗,主要采用解剖钢板固定。拉力螺钉、克氏针作为一种辅助手段,在手术中不宜过多使用。     

Surgical treatment of complex tibial plateau fractures by closed reduction and external fixation. A review of 32 consecutive cases operated

Abstract Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21–64 years). Surgery was performed with patients in transcalcaneal traction and the knee flexed at 30° was used. Through a 1-cm incision centred over the tibial metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation started postoperatively. Weight bearing started after 8–12 weeks depending upon the radiographic appearance. All external fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up of 48 months (range 38–57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing time was 24 weeks (range 18–29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical complications. Mean knee range of motion was 105° (range 75–125°) and mean Knee Society clinical score was 89. Twenty-five results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained. Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for the optimal clinical long-term results.     

双侧侧脑室外引流并脑脊液置换术治疗原发性脑室出血23例

我科自1995年1月至2005年1月共收治原发性脑室出血23例，经双侧侧脑室外引流并脑脊液置换术冶疗取得较好效果，现报道如下。     

NASOGALLBLADDER DRAINAGE FOR MIRIZZI’S SYNDROME

The authors experienced a case of Mirizzi’s syndrome successfully treated with endoscopic nasogallbladder drainage (ENGBD). The patient was a 63‐year‐old man. He was admitted with abdominal pain and jaundice. Laboratory data indicated leukocytosis and elevation of serum bilirubin level. Abdominal ultrasound showed marked swelling of gallbladder and debris in the gallbladder, therefore, the authors strongly suspected Mirizzi’s syndrome. He had past history of acute myocardial infarction and treated with anticoagulation therapy. Then, the authors couldn’t perform surgical removal or percutaneous transhepatic drainage, and tried endoscopic transpapillary drainage. Endoscopic retrograde cholangiopancreatography revealed smooth stricture in the superior portion of common bile duct and occlusion of the cystic duct, and ENGBD was then performed. After ENGBD, his complaints, laboratory data, swelling of gallbladder and stricture of common bile duct were all remarkably improved.     

超声引导下经皮经肝胆管穿刺置管引流在梗阻性黄疸病人中的应用

目的　评价超声引导下经皮经肝穿刺胆管置管引流 (UPTBD)对梗阻性黄疸病人的治疗价值。方法　对 1995年 1月至 2 0 0 2年 7月期间的 4 17例梗阻性黄疸病人进行 4 97次UPTBD治疗 ,并回顾总结他们的临床资料。结果　接受PTBD治疗共有 4 17例 (5 1例病人进行了两个胆管枝的PTBD) ,穿刺成功率达 93.2 % (4 36 / 4 6 8) ,32例首次穿刺失败的病人有 2 9例进行了第二次穿刺置管 ,全部成功。发生胆汁漏 /胆汁性腹膜炎 9例 ,胆道出血 8例 ,感染性休克 1例 ,无腹腔出血、后腹膜血肿、气胸等其他并发症。对 6 4例置管引流患者进行肝功能检测 ,与穿刺前相比 ,引流后 1周和 3周检测病人血清胆红素、转氨酶均显著下降。结论　UPTBD是一项姑息性治疗梗阻性黄疸的快捷、安全、有效的方法     

Laparoscopic choledochotomy with primary closure

Background: Thirty-three patients were candidates for laparoscopic choledochotomy. The indications for this operation are described. Methods: The procedure was completed 32 times (97%). We had 29 successful common bile duct (CBD) clearances, three negative explorations, and one failed clearance which needed to be converted to laparotomy. All the completed procedures ended with primary closure of the main duct. Median duration of surgery was 180 min (range 100–300), including three associated laparoscopic procedures. Results: There were three postoperative complications (9.4%), none major. Average postoperative hospital stay was 7.1 days (range 4–14). In May–June 1995 we controlled 31 out of the 32 consecutive patients (one patient was lost to follow-up) who had a successful laparoscopic choledochotomy from October 1991 to December 1994. Median follow-up was 22 months (range 5–44). Besides clinical control, 23 patients also had ultrasound (US) controls and 24 had blood tests. Eleven had intravenous cholangiotomography. Two patients died 11 and 22 months after the operation for unrelated causes and without biliary symptoms. Two patients had umbilical hernias. One had a small residual asymptomatic stone, which was removed endoscopically. None had signs of postoperative CBD stricture. At US, CBD was ≤7 mm in 15 patients, 8–10 mm in four patients, and 10–12 mm in three patients. The last group had preoperative CBD dilation, too. We could compare preoperative and postoperative CBD diameters in 22 patients: 11 had no change; in nine it decreased; and two had a slight increase (8–10 mm). Conclusions: We conclude that laparoscopic choledochotomy with primary closure is a very good operation: It has a high success rate and low morbidity. Mortality is nil so far. Medium-term results are very positive: We had no CBD stricture and only one case of asymptomatic residual stone, which could have been avoided. Our results suggest that intraductal biliary drainage is useless, and its specific complications are well known. Received: 20 October 1995/Accepted: 28 February 1996     

胸导管引流对慢性哮喘病人外周血淋巴细胞内环核苷酸代谢的影响

观察7例慢性哮喘病人胸导管引流治疗前后外周血淋巴细胞内 cAMp/cGMP 值的变化。结果发现,慢性哮喘病人外周血淋巴细胞内 cAMP/cGMP 的值较正常人低(P<0.001);胸导管引流治疗后,哮喘病人外周血淋巴细胞内 cAMP/cGMP 值较治疗前升高(P<0.01)。提示,慢性哮喘病人外周血淋巴细胞功能异常、活性增强,这可能是哮喘发病的重要原因之一。胸导管引流引起的免疫抑制作用,一个重要的机理就是影响淋巴细胞内环核苷酸的代谢,而使淋巴细胞的活性降低,这可能也是胸导管引流治疗慢性哮喘的机理之一。