The maximally vascularized central pedicle breast reduction: evolution of a technique

A retrospective review of patient medical records was used to evaluate a surgical procedure for reduction mammaplasty. Information obtained during this review was then used to determine areas of possible improvement in patient selection and in surgical technique. Modifications were made, and a second series of patients was treated according to the new selection criteria, and by a modified surgical technique. The medical records of the second series of patients were reviewed. The two series of patients are compared. The initial series includes a retrospective review of data collected on 43 consecutive patients treated for bilateral macromastia using the central pedicle breast reduction technique of Hester and colleagues. The results of this initial series of patients were reviewed and presented at the Northwest Society of Plastic Surgeons Meeting; Lanai, HI, in 1995. Data obtained from that review, resulted in modifications in patient selection criteria and in operative technique by the senior author (RPR). An additional 110 consecutive patients have been treated using this modified protocol. The authors review the same data for the second series of patients and compare the results of the two series. They illustrate the use of the central pedicle technique in 153 patients. They have used the central pedicle reduction mammaplasty technique of Hester and colleagues as a model to demonstrate evolution in a surgical technique after evaluation of data from the medical record. A 50% reduction in complications and a 35% reduction in operative time were obtained.     

The use of a lumbar spine manipulation technique by physical therapists in patients who satisfy a clinical prediction rule: a case series

STUDY DESIGN: A case series of patients with low back pain (LBP) who satisfy a clinical prediction rule (CPR). BACKGROUND: A CPR that identifies patients with LBP who are likely to respond with rapid and prolonged reductions in pain and disability following spinal manipulation was developed and recently validated. The CPR developed to predict favorable response to manipulation investigated the effects of only 1 manipulation technique. The accuracy of the CPR for predicting outcomes using other manipulation techniques is not known. The purpose of the case series was to describe the outcomes of patients presenting to physical therapy with LBP who met the CPR and were treated with an alternative lumbar manipulation technique. CASE DESCRIPTION: Consecutive patients referred to physical therapy who satisfied the eligibility criteria, including the presence of at least 4 of the 5 criteria on the CPR, were invited to participate in the case series. Patients were treated for 2 visits with a side-lying lumbar manipulation technique, followed by a basic range of motion exercise. Patients who exhibited a 50% reduction or greater in disability, as measured by the Oswestry Disability Index (ODI), were considered to have experienced a successful outcome. OUTCOMES: A total of 12 patients participated in the case series. The mean age of the group was 39 years (SD, 8.9 years) and the median duration of symptoms was 19 days (range, 8-148 days). Of the 12 patients who participated in this case series, the mean reduction in disability as measured with the ODI was 57% (SD, 9%). Only 1 patient did not surpass the 50% reduction in ODI scores. DISCUSSION: Eleven of the 12 patients (92%) in this case series who satisfied the CPR and were treated with an alternative lumbar manipulation technique demonstrated a successful outcome in 2 visits. It is plausible that patients with LBP who satisfy the CPR may obtain a successful outcome with either manipulation technique directed at the lumbopelvic region.     

Analysis of the STIF technique for spino-pelvic fixation: clinical results in 19 patients with neuromuscular scoliosis

The STIF (spinopelvic transiliac fixation) technique for lumbosacral fusion was developed by the authors as an alternative to the Luque-Galveston technique. The results observed in this initial series of 27 neuromuscular scoliosis patients treated with the STIF technique are reported. With a minimum of 24 months of radiographic follow-up in 19 patients, the percentage of correction of scoliosis curvature and pelvic obliquity was superior to that reported in the literature. The rates of complications and pseudarthrosis in this series are typical for this patient population. The STIF technique facilitates compression across the sacroiliac joints, which promotes sacroiliac joint fusion and can provide a stable base for curvature correction and lumbosacral fusion. Despite the severe coronal and sagittal plane curves in this group of patients, total operative time also compares favorably to that reported in the literature. The STIF technique requires a well-developed posterior iliac apophysis, which may not be present in younger pediatric patients.     

Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome. Personal experience

AIM: The authors report the results of anterior submuscular transposition, on a clinical series of selected patients with severe cubital tunnel syndrome. In these patients, the degree of ulnar nerve compression was valued using a grading system that includes measurements of motor and sensitive function. In this series, a technique of flexor-pronator mass Z-lengthening was adopted. METHODS: From 1998 to 2002, 18 patients were surgically treated with anterior deep submuscular transposition for cubital tunnel syndrome. The preoperative status was determined using Dellon's classification. Fifteen out of 18 patients were graded as Dellon's grade 3 (severe syndrome). The mean duration of follow-up after surgery was 27.6 months. RESULTS: Postoperative outcome was assessed in all the 15 patients according to a modified Bishop scoring system. Based on this score, 6 patients (40%) were graded as excellent, 7 (47%) were graded as good and 2 (13%) were graded as fair. The complete recovery occurred about 6 months after surgery. None complication was observed. CONCLUSION: Treatment of severe cubital syndrome by means of a technique of flexor-pronator mass Z-lengthening was linked to 87% rate of good to excellent results. The present study demonstrate the feasibility of this technique with restitutio ad integrum in spite of the severity of the syndrome. None failure nor recurrence was present in this series.     

Analysis of a laparoscopic radical prostatectomy program with 544 cases

IntroductionThis article reviews the latest publications that refer to Laparoscopic Radical Prostatectomy (LRP) up to 2005, and describes our series of patients for this type of surgery.Materials and methodsAfter a search of the Internet and consulting journals of renowned prestige, we selected articles that refer to this technique and we summarise the latest developments in LRP. We also present our series of patients.ResultsIn view of the good oncologic and functional results obtained with LRP, and the possibility of performing hernioplasty as in open surgery, this technique provides a high quality service for patients.ConclusionsDue to the advances in the safety and quality of this technique, such as the use of robots, 3 CCD cameras, and the surgeon’s experience, LRP should be offered to our patients, if it is within our means.     

Glossopexy over tracheostomy in the treatment of glossoptosis

We present our series of patients with glossoptosis requiring surgical intervention who were treated successfully by glossopexy, and our reasons for preferring this technique over tracheostomy. We used the technique as described by Randall and we consider this procedure a simple operation with a high success rate and low morbidity.     

Microcervical foraminotomy. A surgical alternative for intractable radicular pain

Utilizing a microsurgical technique that minimizes laminectomy and facet trauma, simple posterior foraminotomy has been used for the treatment of intractable radicular pain in 235 patients with 585 symptomatic cervical nerve roots during the past ten years. The procedure was initially applied as an alternative treatment for patients unresponsive to anterior discectomy and/or laminectomy procedures. The operation accomplishes a thorough decompression of the posterior and inferior walls of the foraminal tube from entrance to exit, without disturbance of the intervertebral disc. All patients in the series experienced resolution of radicular pain by this technique. Correlation between preoperative myelographic defects and surgical pathology became less rewarding as the series matured since the majority of foraminal lesions apparently responsible for root irritation lie outside the spinal canal.     

Acetabular augmentation for the treatment of unstable total hip arthroplasties.

Twenty-eight unstable total hip arthroplasties were treated with an acetabular augmentation wedge. Of the hips, 23 have had no further dislocations at a mean follow-up of 26 months. Five patients continued to dislocate and have needed further surgery. To our knowledge this is the largest reported series of acetabular augmentation with as good results as those of the most successful reported series of this technique, and a success rate comparable to other methods of treating recurrent dislocation. Careful patient selection, and using a thin augmentation wedge to avoid impingement, are important to the success of a technique which is a useful option in the management of recurrent dislocation.     

Transtracheal ventilation in oral surgery

The use of transtracheal ventilation as a routine method of ventilation during anaesthesia for 60 patients with gross pathology requiring oral surgery is reported. Theoretical hazards of the technique and protection of the airway are discussed. There were no serious complications in this series. The technique is recommended as a simple and safe alternative to blind nasal intubation.     

Reduction of postoperative vomiting by preoperative administration of oral metoclopramide

Preoperative oral metoclopramide was evaluated as a postoperative antiemetic agent. Two series of approximately one hundred patients were investigated in this context. One series was carefully controlled with regard to anaesthetic agents and technique. The other series had only one criterion of admission-the exclusion of narcotics. All patients received metoclopramide 20 mg by mouth or a placebo two hours before anaesthesia in a randomized double-blind fashion. A significant reduction in postoperative symptoms of antiperistalsis was observed in the metoclopramide-treated patients. On closer scrutiny it became apparent that, under these circumstances, metoclopramide is significantly more effective in males.     

Prostate brachytherapy

In recent years there has been an increase in the number of centres, especially in the USA, using prostate brachytherapy as a means of treating localised prostate cancer. Several centres now have medium term follow up data of large numbers of patients treated with this technique suggesting that outcome in terms of tumour control may be comparable to patients treated surgically. This review summarises results from different brachytherapy series and outlines some of the possible advantages of this technique compared with current conventional treatments for localised prostate cancer.     

Balanitis xerotica obliterans complicating hypospadias repair.

We review the literature and report a series of eight cases of balanitis xerotica obliterans (BXO) developing in patients following primary hypospadias repair. The ages of these patients ranged from 8 to 25 years with BXO developing from 1 to 16 years postoperatively. Six patients were treated by excision of the BXO tissue and two-stage urethroplasties with full-thickness grafts. Three of these patients had further recurrence of BXO and had re-do urethroplasty using a combination of bladder and buccal mucosa. The last two patients in this series had re-do urethroplasty using bladder mucosa only and bladder-buccal mucosa technique, respectively, as first choice for BXO complicating their hypospadias repair.     

A minimally invasive endoscopic transsphenoidal approach with an endonasal septal pushover technique by using a modified nasal speculum.

Whereas the endoscopic endonasal transsphenoidal approach has been applied in patients with pituitary lesions as a potentially efficacious and less invasive surgical technique, the sinonasal step of a series of the surgical procedures is generally not well known to neurosurgeons. This is one of the reasons why the endoscopic technique has not been fully been adopted as a routine surgical procedure approaching towards the sella. The present paper describes the technical details of a purely endoscopic approach using an endonasal septal pushover technique. We also present a newly designed nasal speculum specialized for this endoscopic endonasal technique. As compared to the endoscopic endonasal approach previously reported, the surgical procedure required for sphenoidotomy with the aid of the modified speculum was simplified and thereby less time-consuming. This technique has been performed in 40 patients with several types of pituitary lesions. All patients recovered rapidly without significant rhinological complications. Despite a limited number of cases, our experience suggests that this simplified endoscopic technique could encourage a more routine use of endoscopes in the endonasal approach for pituitary lesions.     

Double-opposing V-Y inferior gluteal artery fasciocutaneous flaps for the restoration of the intergluteal cleft during reconstruction of large perineal defects

A technique for restoring the intergluteal cleft during the reconstruction of large perineal defects is described. A modification of the bilateral V-Y inferior gluteal artery advancement flaps with double-opposing, deepithelialised dermal flaps is used to recreate the intergluteal cleft. In our series of 15 patients, this technique produced reliable results with high patient satisfaction. We recommend this technique as a reliable and effective modification of the traditional V-Y advancement flap to give a more aesthetically pleasing intergluteal cleft for reconstructing perineal defects.     

Axillary brachial plexus block for perioperative analgesia in 250 children

A cannula technique for axillary brachial plexus block in combination with general anaesthesia has been in use since 1994 for children undergoing surgical correction of congenital hand anomalies. During a 4-year period data were collected on 250 procedures in 185 patients of median age 3 years detailing the block technique and the intraoperative and postoperative analgesic requirements. Fifteen patients (6%) required supplemental intravenous opioid intraoperatively and this is taken as a marker of failure of the block. Ninety-five patients (38%) required postoperative codeine phosphate with a mean time to receiving codeine phosphate of 9 h. Postoperative pain was controlled in this series with oral analgesia in all but six patients who received parenteral codeine. It is proposed that a cannula technique is an effective and safe method of producing axillary brachial plexus block in children.     

Liberal use of emergency center thoracotomy

Emergency center thoracotomy is a heroic technique of resuscitation and treatment which was revived in the 1960s to improve the survival of patients presenting with cardiac wounds. With excellent survival rates attained in such patients, the technique was extended to victims of trauma with other mechanisms and locations of injury. At present, the technique has a survival rate ranging from 3 to 20 percent; however, most recent series of unselected patients show a survival rate of 8 to 10 percent. In this series, there were no survivors when emergency center thoracotomy was utilized after a period of prehospital cardiopulmonary resuscitation. Patients with isolated stab wounds to the thorax, especially those with cardiac injuries, had the best survival rate of any subgroup in the series. If emergency center thoracotomy was utilized for patients with some vital signs on admission and with neck or truncal gunshot wounds, blunt trauma, or abdominal trauma, the survival rate decreased to 2 to 4 percent; however, the small but constant survival rate in all of these groups justifies its continued use.     

Anterior dislocation of the shoulder: a simple method of reduction.

An effective method for reducing anterior dislocation of the glenohumeral joint which does not require either sedation or traction is described. The patient performs the manoeuvre. A series of 32 consecutive patients were treated by this method. Easy reduction was achieved in 72 per cent, with no complications and patients spent less than half as long in the accident and emergency department as when it is not successful. We recommend this simple technique as a first method of reduction in patients presenting to accident and emergency departments.     

Results of the use of a monoblock pin-plate in trochanteric fracture in elderly patients. Apropos of 100 cases

The authors report their experience of the systematic use of a monobloc pin-plate in fractures of the trochanteric region in the elderly. The review of a series of 100 cases with a mortality of 16% demonstrates that this technique ensures excellent results compared with other published series. The biomechanical reliability of the monobloc pin-plate allows immediate weight-bearing in all patients. The technical simplicity and the better preoperative preparation of elderly patients allows an improvement in the postoperative course and consequently in patient survival. This operative technique can be proposed routinely with no restrictions.