Mammaplasty: Shape,volume, and scar size

Recently many mammaplasty techniques have been presented with special attention paid to the resulting scar's size and its position. The surgeon should try to hid the scar, and if the inverted T incision is used, its horizontal branch should be as short as possible and kept in the breast area. Neverthelss, excessive concern about the final scar size should not interfere with the final results of the mammaplasty as far as shape, volume and lasting results are concerned. The author presents his experience in mammaplasty with respect to the volume, the shape, and the scar size interrelationships.     

Posterior cranial fossa dimensions in the Chiari I malformation: Relation to pathogenesis and clinical presentation

Summary Skull dimensions were measured on lateral skull radiographs in 33 adult patients with MRI-verified Chiari I malformations and in 40 controls. The posterior cranial fossa was significantly smaller and shallower in patients than in controls. In the patients, there was a positive correlation between posterior fossa size and the degree of the cerebellar ectopia, which might indicate that a posterior cranial fossa which was originally too small had been expanded by the herniation of hindbrain structures at an early stage. Pyramidal signs and cerebellar symptoms and signs, which may be due to compression of neural structures, were associated with a large degree of ectopia and a relatively large posterior cranial fossa. Syringomyelia and headache, which may be due to the valve action of the herniated cerebellar tissue, were not associated with a particularly large posterior fossa or herniation. No special clinical presentation was associated with a very small posterior cranial fossa, which may indicate that a small posterior cranial fossa per se has little or no clinical significance, although it may be the primary developmental anomaly.     

Genetics: Genetic analysis prior to selective fetal reduction in multiple pregnancy: technical aspects and clinical outcome

Multiple pregnancies resulting from ovarian stimulation areat a higher risk of carrying at least one fetus affected byMendelian or chromosomal anomalies, the incidence of which isdirectly related to the order of multiples. Genetic analysisbefore fetal reduction was offered to both high-and low-riskpregnant women carrying two or more fetuses after ovulationinduction. Chorionic villus sampling (CVS) and fetal reductionwere achieved by transabdominal needling. The use of short-termculture, the polymerase chain reaction and fresh tissue enzymaticanalyses have made it possible for genetic diagnosis to be availablein a few days. A total of 100 patients had multifetal pregnancyreduction performed by a single operator; all of them completedpregnancy and none was lost at follow-up. The total fetal lossbefore 24 weeks was 7% and no statistically significant relationshipwas found with the final number of fetuses and CVS. Perinatallosses (3.9%) were only present in the series with a final numberof two fetuses. Pregnancy duration and birthweight were significantlyhigher in singletons than in twins, but were not related toCVS. The rate of chromosomal disorders was higher (7.2%) inthe study series than in singleton pregnancies not undergoingfetal reduction. Diagnostic error due to incorrect samplingwas reported in 1.5% of cases. These data support fetal reductionas a valuable strategy to improve the outcome of multiple pregnancy.The outcome of pregnancies reduced to singletons was significantlybetter than of those reduced to twins, and was not related toCVS. Therefore, prenatal genetic diagnosis should become anintegral part of counselling on multiple pregnancy, and is stronglyrecommended when reduction to singleton pregnancy is requested.     

下腰痛患者后路手术并发症的防治

目的：分析下腰痛患者后路手术并发症出现的原因，探讨防治办法。方法：回顾分析我科自１９８８～１９９８年６月间采用后路手术治疗下腰痛，即腰椎间盘突出症和／或腰椎管狭窄症患者５７０例的临床资料。结果：３３例发生术后并发症，发生率５．７９％，早期（术后２周以内）并发症１８例，晚期并发症１５例，但无一例并发神经根损伤。结论：除了术中操作技能外，术前严格掌握手术适应证，术后及时观察、早期功能锻炼，都有利于并发症的防治。     

The use of frame fixation in the management of open distal extensor mechanism avulsion fracture in a dislocated knee

An avulsion fracture of the tibial tubercle is a common injury in traffic accident. If the fracture is closed, then a comparatively good prognosis can be expected through reinforcement of the bone via osteosynthesis and the use of artificial ligaments. In this case, an open wound was observed in the tibial tubercle, and the wound was so polluted that the healing process was significantly delayed. It was therefore difficult to provide simultaneous surgical treatment and so three operations were required to perform the reconstruction of the extensor mechanism. The reconstruction of extensor mechanism and the frame fixation between the patella and tibia was performed. Six months after the injury, the patient was able to walk without aid, had a range of movement from 5°to 130°, and did not show any indications of ADL disorder. Using this method of frame fixation between the patella and tibia proved to be an effective technique for the reconstruction of the open knee extension mechanism injury.     

Posterior Acromioclavicular Dislocation with Clavicular Fracture and Trapezius Entrapment

AbstractBackground: Posterior acromioclavicular dislocation is rare. Dislocation associated with fracture of the clavicle and simultaneous entrapment of the lateral end of the clavicle by trapezius muscle has not been reported. Posterior dislocation occurs frequently owing to forceful move of the scapula anteriorly and superiorly or from direct force applied to the lateral end of the clavicle and this may be associated with clavicular fracture. In acute dislocations, open reduction, internal joint stabilization and soft tissues reconstruction have been recommended.Case Study: Acute posterior dislocation occurred in a 32-year-old man. The lateral end of the clavicle was displaced posteriorly and inferiorly, and firmly entrapped in trapezius muscle. The clavicular fracture was undisplaced. The coracoclavicular ligaments were stretched but intact. Open reduction was secured with two smooth Kirschner wires. The disrupted soft tissues were repaired. The clavicular fracture was not explored. Shoulder movement started at 6 weeks. Wires were removed. 10 years later he had pain-free, unrestricted shoulder movement, and the radiographs showed wellreduced, essentially normal acromioclavicular joint.Conclusion: Open reduction, internal joint stabilization and soft tissue reconstruction will result in return and long lasting unrestricted pain-free function of the shoulder.     

Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis

BACKGROUND CONTEXT: Although posterior lumbar interbody fusion (PLIF) for degenerative lumbar diseases is routine, there are few reports on double-level PLIF. PURPOSE: To evaluate the clinical outcomes of double-level PLIF. STUDY DESIGN/SETTING: A retrospective study of operated cases in Gifu, Japan. PATIENT SAMPLE: Nineteen patients (8 men and 11 women, 59.5+/-10.2 years) who underwent double-level PLIF between 1996 and 2001. OUTCOME MEASURES: Operation time, blood loss, complications, the Japanese Orthopaedic Association (JOA) score for back pain and lumbar sagittal alignment were evaluated. METHODS: Patients were examined retrospectively at follow-ups of 3.6+/-1.7 years. Primary diseases were spondylolisthesis, spinal canal stenosis, degenerative scoliosis and herniated intervertebral disc. Fusion areas were L3 to L5 in 15 cases and L4 to S1 in 4 cases. RESULTS: The mean JOA score increased from an initial score of 12.9+/-3.5 to 21.3+/-4.9 at the final follow-up. There was a positive correlation (R=0.718, p<.001) between the increase in lordotic angle and the increase in the JOA score. Several parameters suggested that the surgical invasiveness was not minimal. CONCLUSION: Double-level PLIF provided satisfactory results and preserved lumbar spine lordosis.     

Thickness effects of a carbon-supported platinum catalyst layer on the electrochemical reduction of oxygen in sulfuric acid solution

The influence of the thickness of a carbon-supported platinum catalyst layer on the oxygen reduction reaction (orr) has been studied in sulfuric acid solution by means of a thin-film rotating disk electrode. Pronounced changes in the Pt utilization, electrode activity and the orr kinetics have been observed upon varying the catalyst layer thickness. The thicker film electrode exhibits a higher Pt utilization efficiency and higher activity, and promotes the orr kinetics at potentials relevant to fuel cell operations. The participation of Pt surfaces not in contact with the electrolyte solution in electrochemical reactions via the spillover of adsorbed hydrogen and oxygen species, is proposed to be responsible for the changes. The thicker catalyst layer is likely to modify the Pt particle–particle distance by providing shared Pt sites between adjacent carbon supports, to improve the surface density of active catalyst particles per single carbon support by sharing adjacent catalyst sites, and to increase the ratio of the particle surfaces free of blocking anions to the catalyst|electrolyte interface surfaces. The carbon-supported platinum catalyst layer becomes active at 0.90 V vs RHE only when the catalyst layer is thicker than 1 μm. To provide reasonable activity, the minimum catalyst layer thickness should be around 2–4 μm. These results should be considered in the design of the cathode catalyst layer of polymer electrolyte membrane fuel cells.     

开放复位可塑形钛板内固定治疗跟骨骨折33例

目的 评价开放复位可塑形钛板内固定治疗跟骨骨折的疗效。方法 对33例(37足)以后关节突移位为主的跟骨骨折,行跟骨外侧入路、开放性复位可塑形钛板螺钉内固定,必要时行植骨术(18例)。结果 平均随访11.5个月,参照Mary—land food score评分,对患足是否疼痛、步态、距下关节及踝关节活动度、是否支架辅助、术后X线摄片等加以评估,19足疗效为优,17足为良,1足可。其中钛板断裂1例,手术切口皮缘坏死1例,换药后自愈。结论 跟骨外侧入路开放复位可塑形钛板螺钉内固定,必要时植骨术是治疗跟骨骨折的有效方法。