Neck Rejuvenation with Fractional CO2 Laser: Long-term Results

Objective: To assess the effectiveness of 10,600nm fractional CO₂ laser for neck aging at one month and one year after treatment. Design/Setting/Participants/Measurement: Twenty patients underwent 10,600nm fractional CO₂ laser treatment over the entire neck. Clinical features of the patients were classified according to Baker classification. The degrees of skin laxity, jowling, fat deposition, and horizontal neck lines were evaluated using a 9-point scale, prior to treatment at one month and one year after the treatment. The patients were independently assessed by the authors at two different times in a blinded fashion. Results: Skin laxity, jowling, fat deposition, and horizontal neck lines scores were significantly lower than the baseline values at one month and one year. One-year follow-up values of the same parameters were still significantly lower than the baseline. No persistent complication developed after treatment. Conclusion: The results of this study confirm that fractional CO₂ neck rejuvenation is an effective treatment option with long-term efficacy for patients who mainly have skin laxity and jowling together with skin surface pigmentation.A esthetic improvement of the aging neck remains one of the most challenging aspects of antiaging procedures. Although a variety of surgical and nonsurgical techniques have been targeted in this area, most of the patients become dissatisfied with the treatment results. This difficulty is mainly due to the complexity of the aging phenomenon of this particular area. The neck aging may be related to loss of skin quality, deposition of submental fat, decrease in muscle tone, changes in weight, and sun damage.1Several methods have been recommended for the treatment of neck aging. These include tumescent liposuction, laser-assisted liposuction, minimally invasive skin tightening, radiofrequency, intense focused ultrasound, onabotulinum toxin A injections, ablative or nonablative laser resurfacing, and other surgical lifting procedures, either alone or in combination. A thorough understanding of the various components of neck aging is essential to select the appropriate therapy or combination therapies. Most of the patients require a combination of these treatment modalities to have a better clinical outcome as they exhibit several factors contributing to neck aging.1-5In recent years, the concept of fractional photothermolysis has become very popular in skin rejuvenation by decreasing recovery time, risk of side effects, and complications while achieving clinical results approaching those seen with traditional CO₂ laser resurfacing. Fractional CO₂ laser produces an array of microthermal treatment zones in a pixelated fashion, with a confluent pattern of ablation and coagulation extending from the stratum corneum through the dermis. Rapid wound healing is provided by viable keratinocytes in the untreated islands of surrounding skin. Fractional CO₂ laser has been shown to provide a safe and effective rejuvenation with significant effects on skin tightening and texture.6,7     

A Modified Raz Bladder Neck Suspension Operation (Transvaginal Burch)

A total of 36 female patients with genuine stress urinary incontinence underwent Raz needle suspension with fixation of suspension sutures to the iliopectineal ligament (transvaginal Burch procedure). By fixing suspension sutures to the iliopectineal ligament we expected to achieve a static suspension independent of everyday patient activities. Considering the small number of patients and limited followup, our results revealed continence in 80 to 85 percent of the patients after 3 years. We believe that fixation of suspension sutures to the iliopectineal ligament can favorably influence long-term results of needle suspension in the treatment of female stress urinary incontinence.     

透明质酸填充联合肉毒毒素在颈部年轻化中的应用效果

目的 探讨透明质酸填充联合肉毒毒素在颈部年轻化中的应用效果。方法 选取我院2020年9月-2022年9月收治的颈部衰老行年轻化治疗的74例患者为研究对象,按照随机数字表法分为对照组与联合组,每组37例。对照组使用透明质酸填充治疗,联合组使用肉毒毒素联合透明质酸填充治疗,比较两组颈纹分级和Antera凹陷体积、临床疗效、疼痛程度、副反应发生情况及满意度。结果 两组治疗后颈纹分级及Antera凹陷体积低于治疗前,且联合组低于对照组（P＜0.05）;联合组治疗总有效率为89.19%,高于对照组的67.57%（P＜0.05）;两组VAS评分及副反应总发生率比较,差异均无统计学意义（P＞0.05）;联合组患者、第三者及操作者满意度评分均高于对照组（P＜0.05）。结论 透明质酸填充联合肉毒毒素有助于提高颈部年轻化的治疗效果,在不增加疼痛程度和副反应的同时,提高患者满意度及美容效果。     

Pharmacokinetics of controlled release morphine (MST) in patients with liver cirrhosis

We have studied the kinetic profile of controlled release morphine (MST) in 12 patients with posthepatitic cirrhosis, caused by HCV and HBsAg, with portal hypertension, given MST 30 mg for endoscopic sclerotherapy and compared the data with those from 10 healthy controls. Plasma drug concentrations were measured in venous blood samples at intervals up to 12 h by high-pressure liquid chromatography (HPLC). Total body clearance (Cl) and systemic availability were estimated using a compartmental method. Patients with cirrhosis had less clearance (0.586 litre h-1) than controls (0.729 litre h-1). Mean residence time (MRT) was prolonged in cirrhotic patients (19.57 h) compared with controls (7.03 h). Elimination half-life in cirrhotic patients (mean 7.36 (SEM 0.45) h) was nearly twice that of controls (4.01 (0.15) h). Serum concentrations were higher at all sampling times in the cirrhotic patients (peak concentration 35.2 (3.2) ng ml-1 compared with 12.8 (0.4) ng ml-1 in controls). For these changes in the kinetic profile of morphine (as MST) in cirrhotic patients, who experienced more sedation than controls, a smaller dose study together with longer dosing intervals is recommended.      

Pharmacokinetics of controlled release morphine (MST) in patients with liver carcinoma

Background. There are no studies reported on the pharmacokineticsof controlled release morphine (MST) in patients with hepatocellularcarcinoma, the fifth most common cancer in the world. Methods. We have studied the pharmacokinetic profile of MST(30 mg) in 15 patients with liver carcinoma (eight with primarycarcinoma on top of chronic hepatitis C, and seven with secondarymetastatic liver malignancy as a result of other primary) comparedwith our previously published data for 10 healthy controls.Plasma morphine concentrations were measured in venous bloodsamples at intervals up to 12 h by high-pressure liquid chromatography.Total body clearance (Cl) and systemic bioavailability wereestimated using a compartmental method. Results. Morphine bioavailability showed a substantial increasein patients with primary liver and secondary metastatic carcinomathan that of controls (64.8, 62.1, and 16.8%, respectively).The area under the serum concentration–time curve increased4-fold in primary carcinoma (416 [SEM25] µg h^–1litre^–1) and 3-fold (303 [21] µg h^–1 litre^–1)in metastatic liver patients compared with healthy control (92.5[3] µg h^–1 litre^–1). No significant differencewas found in T_max between the two malignant groups but C_maxwas significantly greater in primary liver carcinoma patients.Impaired morphine elimination was noted in primary carcinomaonly (t_1/2 5.99 [0.39] h). Conclusion. Careful administration of morphine is recommendedin patients with liver cancer.     

PREMEDICATION WITH SLOW RELEASE MORPHINE (MST) AND ADJUVANTS

Sixty-one women undergoing major gynaecological surgery receivedslow release morphine (MST) 60 mg, with placebo, hyoscine 0.6mg or diazepam 10 mg, by mouth 2 h before sugery. Plasma morphineconcentrations reached a steady level usually within 3 h afteradministration of MST, and did not increase after surgery unlesssupplementary opioid was given. Hyoscine delayed morphine absorption.Before operation no fewer than 50% of patients were sedatedafter MST alone, but this increased to 85% after MST and diazepam.Similarly, only the combination MST and diazepam produced anxiolysis.Postoperative mood was unhappier after MST and hyoscine. Emesisoccurred in 40–57% of patients, and was not reduced byhyoscine. Therefore premedication with MST alone did not producereliable sedation or anxiolysis. A combination of hyoscine andMST premedication cannot be recommended, as it did not producesedation, anxiolysis or antiemesis and may have delayed morphineabsorption.     

Comparison of oral slow release morphine (MST) with intramuscular morphine for premedication

Oral morphine sulphate slow-release (MST) 40 mg and intramuscular morphine sulphate 10 mg, each administered with intramuscular atropine 0.6 mg, were compared in a randomised double-blind trial as premedication agents in 30 patients undergoing abdominal hysterectomy. Both formulations produced sedation but no anxiolysis in the anaesthetic room, as measured by 10 cm, horizontal linear analogue scales. There was no significant difference between the preparations in terms of postoperative pain, recorded either by the linear analogue scales or using a patient questionnaire. The usage of analgesics and anti-emetics postoperatively was comparable in both groups.     

桡骨头与桡骨颈成角移位骨折手术方法的改进

目的：探索桡骨头与桡骨颈成角移位骨折的手术复位和内固定方法的改进与效果。方法：自１９８６～１９９８年间,对成角移位＞３５°的桡骨头与桡骨颈骨折施行手术切开截骨复位,自体骨楔形骨块嵌入植骨固定术治疗１５例。结果：１３例获６个月～１０年随访,全部病例均获骨性愈合,功能恢复良好。结论：截骨复位效果优于传统的撬拨复位。植骨固定可靠、植骨量少,手术操作简便。     

Rejuvenation of Photoaged Skin: 5 Years Results with Intense Pulsed Light of the Face, Neck, and Chest

BACKGROUND: Photorejuvenation involves the use of lasers or light sources to reverse signs of photoaging. Multiple devices have been shown to be effective over the short-term. OBJECTIVE: To investigate the long-term clinical results on the face, neck and chest at 4 years using filtered flashlamp intense pulsed light (IPL) for treatment of photoaging changes of telangiectasias, dyspigmentation, and rough skin texture. METHODS: A chart review of 80 randomly selected patients with skin types I-IV who were treated by IPL during 1996 and 1997 was performed. Photos and patient self-assessment were graded for features of textural smoothness, telangiectasia severity, and blotchy pigmentation into four categories of worse, no change, slightly better (less than 50% improvement) and much better (greater than 50% improvement). RESULTS: At 4 years following initial treatment, skin textural improvement was noted in 83% of the subjects. Telangiectasias were improved in 82% of subjects, while pigmentation remained improved in 79%. The median number of treatments was 3. The face responded slightly better than the chest or neck. Most common side-effects included temporary mild crusting (19%), erythema (15%) and purpura (6%). CONCLUSION: Signs of photoaging including telangiectasias and mottled pigmentation of the face, neck, and chest, can be improved by IPL with a long-lasting result. Minimal or no downtime with minimal adverse effects can be achieved with the settings reported. Skin textural smoothing, although not easily quantified, is an additional benefit observed long-term.     

面部（额颞部）除皱术与自体脂肪填充术联合方案在面部年轻化手术中的应用

目的 探析面部（额颞部）除皱术与自体脂肪填充术联合方案在面部年轻化手术中的应用效果。 方法 选取2019年1月-2023年6月于本院就诊的面部年轻化手术患者100例作为研究对象,采用随机信封分 组法分为对照组和观察组,各50例。对照组采取面部（额颞部）除皱术治疗,观察组采取面部（额颞部） 除皱术与自体脂肪填充术联合方案治疗,比较两组治疗前后瞳孔点至鼻唇沟与瞳孔垂线交点距离、生活质 量评分、临床疗效、美容满意率、并发症发生率。结果 观察组瞳孔点至鼻唇沟与瞳孔垂线交点距离低于 对照组（P＜0.05）;观察组治疗后生活质量评分高于对照组（P＜0.05）;观察组治疗总有效率为98.00%, 高于对照组的84.00%（P ＜0.05）;观察组美容满意率为98.00%,高于对照组的86.00%（P＜0.05）;观察组 并发症发生率高于对照组,但差异无统计学意义（P ＞0.05）。结论 对于面部年轻化手术患者,面部（额 颞部）除皱术与自体脂肪填充术联合方案的治疗效果良好,可缩短瞳孔点至鼻唇沟与瞳孔垂线交点距离, 提升生活质量,且患者对美容满意度较高。     

RELATIVE BIOAVAILABILITY OF CONTROLLED RELEASE MORPHINE TABLETS (MST CONTINUS) IN CANCER PATIENTS

The bioavailability of oral controlled release morphine tablets(MST, Napp Laboratories) and oral morphine sulphate in aqueoussolution (MSS) was compared in 10 patients with advanced cancer.Serum samples were analysed for morphine, morphine-3-glucuronide(M3G) and morphine-6-glucuronide (M6G) using a specific HPLCassay. The relative bioavailability of morphine with MST wassignificantly less than that with MSS (mean 80%, range 50–110%)although there was no difference between the formulations inthe relative availability of M3G and M6G. There was no significantdifference between the formulations in the serum concentrationof morphine at 12 h. The mean ratios morphine: M6G: M3G (comparingareas under the serum concentration-time curves) were 1:9:56.There was a highly significant linear relationship between thedose administered and AUC for morphine, M3G and M6G after MSS;and for morphine after MST. Median t_max for morphine was 0.5h with MSS and 2.5h with MST; for M3G 1.5h with MSS and 3.0hwith MST; and for M6G 1.5h with MSS and 3.25h with MST. A secondarypeak of unconjugated morphine, which may represent enterohepaticcirculation, was seen in several patients 2–4h after administrationof elixir and 4–6 h after administration of MST. ^*Institut Gustave-Roussy, rue Camille Desmoulins, 94805 VillejuifCedex, France. ^**Leeds General Infirmary, Leeds LS1 3EX.     

Collagenous Fibroma (Desmoplastic Fibroblastoma) of the Neck Presenting with Neurological Symptoms

Collagenous fibromas are rare fibrous soft tissue tumours that usually arise in subcutaneous tissue or skeletal muscle at a variety of anatomical sites. These lesions commonly present as painless, slow-growing mobile masses. We describe a unique case of a 41-year-old woman presenting with a posterior neck swelling and longstanding history of severe ongoing pain in the right scapular region, shoulder and neck, weakness of the palmar grip and limited right lateral neck flexion and rotation. A history of trauma to the right neck in adolescence was noted. Histological analysis revealed a paucicellular lesion with spindle and stellate-shaped fibroblasts involving the cervical nerve roots, typical of collagenous fibroma. In a literature search on Medline and Pubmed, we found no reported cases of collagenous fibromas presenting with neurological symptoms. This report highlights the potential of these lesions to present with neurological symptoms due to infiltration of surrounding tissues, and that preceding trauma may contribute to the aetiology.     

Congenital Cartilaginous Rests of the Neck (Wattles)

BACKGROUND: Congenital cartilaginous rests of the neck (wattles) are very rare, probably branchiogenic malformations. OBJECTIVE: To discuss the clinical and histologic features and the therapy of wattles. METHODS: We report a 4-year-old patient with symmetric exophytic nodules of the neck that had been present since birth. RESULTS: The two lesions, 0.5 3 0.5 cm, were removed. The histopathologic examination confirmed ectopic cartilaginous tissue. CONCLUSION: Wattles must be excised, including their cartilaginous core, after having sonographically excluded fistulae or sinuses.     

Postural Correction in Persons with Neck Pain (II. Integrated Electromyography of the Upper Trapezius in Three Simulated Neck Positions)

In the previous paper (Enwemeka, Bonet, Ingle, et al. 8:235-239, 1986) we showed that patients with neck pain and spasm of the upper trapezius often assume a forward head position, and that two neck positions, axial extension, and neutral neck position are frequently used by physical therapists to correct this faulty neck posture. Because there is no scientific basis for recommending either of the two corrective neck positions, we simulated the three neck positions in 10 normal adults and compared the integrated electromyography (IEMG) of the upper trapezius to determine if the muscle shows less activity in any of the two corrective positions. The results showed significantly less IEMG of the upper trapezius in each of the two corrective neck positions than in the faulty neck position (p < 0.001). No statistically significant difference was found between the IEMGs recorded in the two corrective neck positions (p > 0.10). The implications and limitations of these findings are discussed along with suggestions for future studies. J Orthop Sports Phys Ther 1986;8(5):240-242.     

Multipass Vector (Mpave) Technique with Nonablative Radiofrequency to Treat Facial and Neck Laxity

Background. Redundant facial and neck skin is a major feature of aging and historically has been corrected surgically. Recently, monopolar radiofrequency application has been introduced for nonablative tissue tightening of skin by volumetric heating of the deep dermis. It has been able to improve neck and cheek laxity and periorbital rhytides and to elevate eyebrows. However, questions remain as to the ideal parameters needed to optimize the use of radiofrequency.
Objective. To determine the safety and report on the efficacy of a radiofrequency application that involves a multipass vector (mpave) technique to target facial and neck skin laxity.
Methods. Twenty-five patients (skin types I to V) with mild to severe facial and neck laxity received one treatment session with monopolar radiofrequency. Treatment parameters, adverse events, and digital photographs were recorded. All patients were treated with a multipass vector technique consisting of four to five passes targeted over areas of skin that would most improve facial laxity. The multipass vector (mpave) treatment approach is described. Energy levels ranged from 62 to 91 J/cm2 per pulse.
Results. All patients experienced some immediate erythema and edema, which had completely resolved in most patients within 48 hours. No scarring or dyspigmentation was noted on follow-up at 6 and 12 weeks. Photographic analysis of pre- and post-treatment digital images revealed cosmetic improvement in facial and neck laxity in 96% of patients. The majority of patients demonstrated a moderate or better improvement. Stacked pulses in the submental region were shown to reduce fat.
Conclusions. The direct application of monopolar radiofrequency to facial and neck skin using a multipass vector (mpave) treatment approach was safely tolerated in patients of all skin types. Patient satisfaction correlated well with photographic analysis, and the technique was shown to be efficacious for most patients.     

髋臼骨折合并同侧股骨颈骨折的治疗

目的 探讨髋臼骨折合并同侧股骨颈骨折的临床特点及治疗方法。方法 本组共4例患者,男3例,女1例,年龄17～63岁,平均年龄为43.6岁。均为闭合性骨折。髋臼骨折3例行重建钢板内固定,1例行拉力螺丝钉内固定;股骨颈骨折2例行空心螺钉内固定,1例行动力加压螺纹钉内固定,1例行全髋关节置换术。结果 4例患者随访14～67个月,平均39.3个月。优3例,良1例。结论 髋臼骨折合并股骨颈骨折为少见、复杂而严重损伤,常合并多部位、多系统损伤。应尽早行手术治疗,并根据两处骨折的不同类型选择手术次序及方案。手术治疗髋臼骨折合并股骨颈骨折是纠正移位、稳定骨折和改善关节功能的有效方法。