Elbow Arthroscopy Made Simple: Indications and Techniques

Elbow arthroscopy is a technically demanding procedure. A comprehensive understanding of the elbow neurovascular anatomy combined with a very detail-oriented technique for portal placement helps to minimize risk and facilitates performing elbow arthroscopic procedures effectively and safely for the appropriate indications. The technique for establishing all portals is critical regardless of which portals are used. Care should be taken to thoroughly palpate the bony landmarks before establishing any portal site, and only blunt trocars should be used for elbow arthroscopy. Identification of the ulnar nerve is critical to avoid nerve injuries. In addition, only the skin should be incised, with a hemostat used to dissect through deeper tissues, in an effort to protect the superficial nerves. Likewise, although accurately measuring distances from the bony landmarks is important when planning portal-site locations, elbow sizes and shapes are highly variable. Therefore, recognition of an individual patient's body size and habitus is a key step before establishing portals. The use of anterior proximal portals also allows for improved visualization of anterior structures in a safe manner (distant from nerves). Finally, insufflating the elbow joint before establishing the initial anterior compartment portal has been reported to increase the distances of the nerves from the portal-site cannulas. An additional reason to consider insufflating the joint before portal placement is that insufflation increases anterior capsular tension, making penetration of the capsule with the blunt trocars easier and more reliable. In summary, elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint.     

小儿单纯性阴茎下弯的手术治疗

小儿先天性单纯阴茎下弯１８例，年龄２－１３岁，Ⅰ型６例，Ⅱ型９例，Ⅲ型３例。用两种术式进行矫正，１４例一期治愈。４例发生尿瘘或弯曲矫正欠满意。对两种术式的疗效比较，尿道松解术简单易行，并发症少，不需膀胱造瘘，疗效较好，可作疗先天性阴茎下弯的首选术式。对并发症发生的原因和预防进行讨论。     

Simple method of elongating a colonic segment for esophageal replacement

Occasionally the surgeon is confronted with a major problem that can be solved easily if he has been alerted to an applicable and simple maneuver. Several years ago Najafi and Beattie¹ employed such a maneuver in elongating a piece of colon to bridge a gap in an adult with extensive stricture of the esophagus. Although their technique would not seem feasible with the colon of an infant, they did call attention to the fact that the teniae coli, rather than the blood supply, limited the stretching of the colonic segment. It is this point that deserves emphasis and justifies the following report.     

Simple external fixation of open and complicated fractures

Thirty patients were managed with the use of a simple means of external fixation. Ten of these patients had multiple injuries. In 18 the fractures were open. Five cases had loss of bone length and infected wounds when first seen and were treated with the aid of microvascular surgical procedures. Eight cases required skin grafting. One case required a vein graft to the popliteal artery. The method described is simple to use. It requires little previous experience and is cost effective. We recommend its use in the initial treatment of grade 2 and 3 open fractures. It may also be used on closed unstable fractures, and will maintain limb length in severe injuries with loss of bone substance while further treatment is considered or performed.     

Simple reconstruction of anteromedial rotational knee stability

A technically simple operation for the restoration of anteromedial rotational knee stability is described. It involves suturing under tension the posteromedial capsule of the knee joint to the semimembranosus tendon at its insertion into the tibia, with the leg held in full internal rotation and with the knee flexed to 60 °. This, in combination with the conservative treatment of meniscal injuries and with tightening of the soft tissue structures over the medial aspect of the knee, restored full or almost full anteromedial stability in the knee in 15 out of 16 young men, observed for an average of 19 months after the operation.     

Simple mechanical method for decreasing the incidence of thromboembolism

Increasing awareness of the dangers of low dose heparin therapy has stimulated interest in mechanical methods for decreasing the incidence of thromboembolism. Plantar flexion and dorsiflexion of the feet while the patient is on the operating table by the use of a mechanical device (the Pedi-Pulsor) significantly decreases the incidence of deep vein thrombosis (45 percent in control patients versus 18 percent with the Pedi-Pulsor [p = 0.05]). In addition, use of this machine during the postoperative period should further aid in decreasing the incidence of thromboembolism.     

Simple invasive fixation device for fractionated stereotactic LINAC based radiotherapy

Summary.  Background: The aim of this study was to develop a relocatable fixation device for linear accelerator (LINAC) based fractionated stereotactic radiotherapy.  Method: The device consists of a CT- and MRI-compatible stereotactic frame, monocortical titan bone screws, four frame-posts with a lock for the fixation pins and a modified head clamp with additional arms that allows the exact and rigid placement of the frame in the desired final position prior to the final placement of the bone screws. By simply disconnecting the lock from the posts, the frame can be dismounted after treatment planning and after each treatment session. The accuracy of reposition was assessed prospectively, using phantom studies and also by comparison of isocenter movements during fractionated radiotherapy in 10 patients with an intracranial lesion.  Findings: No adverse events were seen after the surgical procedure and the screws were well tolerated throughout the course of treatment. The mean isocenter shifts observed during phantom reposition studies were x=0.05 mm, y=−0.32 mm, z=0.18 mm and the mean isocenter shifts during fractionated treatment were x=0.67 mm, y=0.65 mm, z=0.44 mm.  Interpretation: This new fixation device provides excellent accuracy of reposition during stereotactic radiotherapy. It appears superior to non-invasive, mask fixation techniques. Safety margins as small as 1–1.5 mm may therefore be sufficient for this method of stereotactic radiotherapy. Published online April 28, 2003  Correspondence: Dr. Oliver Ganslandt, Department of Neurosurgery, Schwabachanlage 6, D-91054 Erlangen, Germany.     

单纯型腰椎间盘脱出症的经皮穿刺切除治疗

作者采用经皮穿刺腰椎间盘髓核抽吸切割术治疗单纯型腰椎间盘脱出症46例,其中34例完全治愈,8例症状明显缓解,4例无效。未出现明显并发症。作者认为应注意严格选择适应证、准确定位、合理操作和良好的术后护理等才能获得安全、有效的结果。     

A Simple Technique of Placing Temporary Atrial Pacemaker Electrodes

A simple method of placing temporary atrial pacemaker wires in open-heart operations is presented. The technique requires no sutures, uses ordinary metallic clips, and is free from complications.     

急性单纯性阑尾炎抗生素使用的策略及其价值的临床观察

目的:探讨对于急性单纯性阑尾炎患者抗生素使用策略及其临床价值。方法:选取2016年2月1日—2019年2月1日我院普外科所收治的60例急性单纯性阑尾炎患者,随机分成对照组(行阑尾切除手术治疗)和观察组(使用抗生素类的药物治疗),每组30例,比较治疗前后两组临床相关指标、临床疗效及并发症发生情况,比较治疗前后两组白细胞计数、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平。结果:观察组体温恢复正常时间、下床活动时间与住院天数均明显短于对照组(P<0.05),疼痛缓解所需时间两组无显著差异(P>0.05);对照组临床治愈率为93.33%(27/30),高于观察组76.67%(23/30)(P<0.05);观察组治疗后并发症发生率为6.67%(2/30),低于对照组的13.33%(4/30)(P<0.05);治疗前两组白细胞计数及炎性因子水平无差别(P>0.05),治疗1周后观察组白细胞计数、IL-6、TNF-α、CRP水平分别为(8.07±0.82)×109/L、(27.66±4.85)ng/mL、(1.48±0.33)mg/L、(60.54±12.87)mg/L,较对照组低[白细胞计数、IL-6、TNF-α、CRP水平分别为(10.14±0.96)×109/L、(49.78±5.37)ng/mL、(2.21±0.41)mg/L、(91.32±13.16)mg/L](P<0.05)。结论:对于急性单纯性阑尾炎的患者使用抗生素治疗,虽存在一定的复发倾向,但能有效改善患者临床相关指标及降低并发症发生率,减轻患者炎性反应。     

Simple Method for Teaching Coronary Artery Surgery

This simple bench model facilitates the development of technical skills in coronary artery surgery and permits unlimited practice of the maneuvers involved.     

A Simple Model of the Hemodynamic Effects of a Proximal Coronary Artery Narrowing

A simple mathematical model of the hemodynamic effects of a discrete proximal coronary artery obstruction is presented. The model demonstrates that resting myocardial flow demands fail to be met when the vessel diameter is decreased by 75% or greater. More strikingly, it shows that the maximum flow obtainable for increased myocardial oxygen demand begins to fall significantly with a lesion causing a 40 to 50% obstruction. The implications of these findings in relation to stress-induced angina are discussed.     

Simple mastectomy for early and advanced mammary carcinoma

Simple mastectomy was used to treat 111 women with invasive mammary carcinoma. In none of eighteen patients with cancer clinically confined to the breast did local recurrence develop after simple mastectomy, but metastases developed in the axilla in three. Adjuvant irradiation, castration, or drug therapy did not improve the survival or ultimate local control achieved by simple mastectomy.No significant difference was demonstrated in survival after simple and radical mastectomy for comparable clinical stages of disease.