The extended minimal incision approach to midface rejuvenation

Recent major advancements in comprehensive facial rejuvenation have focused on management of midfacial aging. Multiple techniques have been described to treat the aging midface; the mere nature of so many approaches is evidence that no one technique has prevailed. Although the nasolabial region remains a challenge to correct, the approach described herein provides comprehensive rejuvenation of the midface, lateral brow, and jawline. The technique is performed via a minimal incision brow-lift approach and has been performed (with minor modifications) by the senior author in more than 650 patients over the past 9 years. The technique has proven to be safe, reliable, and effective.     

The floppy Nissen fundoplication. Effective long-term control of pathologic reflux

In 1976 we defined a technique of "floppy" Nissen fundoplication (FNF) that prevented experimental pathologic reflux without preventing gaseous eructations or vomiting (normal reflux) when appropriate. This report describes the one- to eight-year follow-up of the 77 patients operated on since that time. The FNF has been completely effective in preventing pathologic reflux in 75 of 77 patients and has been partially effective in two others who are now subjectively asymptomatic. Adverse side effects were reported by two patients, one with gas-bloat and one with inability to belch or vomit. The lower esophageal sphincter pressure of patients postoperatively was increased to low normal values from a mean of 8.94 +/- 1.66 to 14.31 +/- 0.7 mm Hg (normal, 21.2 +/- 4.2 mm Hg). Since FNF does not cause greatly increased lower esophageal sphincter pressure, the inference that the FNF prevents reflux by altering the physiology of a reflux event is supported. In conclusion, the floppy fundoplication has been an effective operation with a low incidence of adverse side effects and without a tendency for late failure.     

The management of female incontinence by suprapubic catheterisation, with or without urethral closure

Thirty-two female patients with continued urinary incontinence, following a period of urethral catheterisation, have been treated by suprapubic catheterisation. A technique is described for closure of the female urethra and this has been effective in 20 out of 24 patients. The procedure has been undertaken in some patients with advanced neurological disease and in the presence of pressure sores.     

The combined spinal--epidural technique

In recent years, the use of regional anaesthesia techniques for surgery, obstetrics and post operative pain management have increased in popularity. The combined spinal-epidural (CSE) technique has attained widespread popularity for patients undergoing major surgery below the umbilicus who may require prolonged and effective postoperative analgesia. The CSE technique is now well established in several institutions. This chapter includes the clinical experience, advantages and potential problems, and discusses future perspectives of the CSE technique.     

The Use of Combined Anteversion in Total Hip Arthroplasty for Patients With Developmental Dysplasia of the Hip

The combined anteversion technique has been proposed recently and proved to be an applicable technique in general THA. The corresponding author routinely applied this approach to DDH patients in clinical practice. The current study aimed to provide clinical evidence for this approach. We studied 35 DDH patients (47 hips). Every patient underwent pelvic CT scans before and after surgery and the HHs was recorded. The data indicate a high accuracy of controlling components orientation and satisfactory clinical outcomes. Using this approach, we reduced dislocation risk and got better impingement free range of motion. Therefore, we conclude that combined anteversion is effective for DDH patients who receive a THA. This approach could guarantee stable and functioning joints for DDH patients receiving THA.     

The septic abdomen: open management with Marlex mesh with a zipper

The "open" abdomen has gained popularity in the management of severe intraabdominal sepsis. Drawbacks include evisceration, need for ventilator support, and recurrent abdominal sepsis. We have applied a more aggressive and effective technique consisting of abdominal "closure" with a Marlex mesh sheet containing a zipper. Manual exploration and lavage is performed daily through the zipper in the surgical intensive care unit. Ten patients with severe abdominal sepsis were treated for the following: fecal peritonitis (three patients), radiation enteritis with fistula (one patient), diverticular abscess and dehiscence (one patient), diffuse postoperative abdominal sepsis (two patients), and necrotizing pancreatitis (three patients). Thirteen meshes were inserted, four at first operation and nine at the second to sixth operations. Eight patients survived (80%). Only three patients required respirators; two died. Two patients underwent drainage of three defined abscesses in the surgical intensive care unit. Three patients underwent five major operations through the zipper. Intestinal stomas were present adjacent to the mesh in six patients and were not a management problem. No fistulas resulted from this technique. The Marlex/zipper was removed when all septic signs abated and adhesions were allowed to form (average of 10 to 12 days). Daily aggressive manual lavage of the abdomen through a Marlex mesh/zipper is rapid, simple, and well tolerated. It has permitted effective management of severe septic peritonitis and easier wound care. This technique merits further controlled trials to ascertain its ultimate benefit in survival.     

The radical minimal access thoracoplasty by funnel chest in adults

A new technique of radical thoracoplasty, performed with a small size incision, using the sternocostal complex fixation with nitinol plates with shape memory and the surgical toolkit required for the purpose, has been successfully introduced. 23 patients underwent surgery using the technique. Tree patients had early postoperative complications: 2 cases of exudative pleurisy and 1 case of bronchitis aggravation. Good cosmetic results was achieved in all operated patients. The mechanical ground of the technique is based on the use of the effective force of the sternum traction and the pressure of the plate on the tissues below. The main advantage of the method is avoidance of the transverse sternotomy.     

The efficacy of blood conservation technique for coronary artery bypass graft surgery]

To evaluate the efficacy of blood conservation technique at our center, 144 patients undergoing primary coronary artery bypass grafting were studied between Jan. 1988, and Dec. 1990. Combined intraoperative and postoperative autotransfusion technique reduced the requirement of homologous blood to a half and 24% of the patients were without homologous transfusion. With more use of dilutional autotransfusion, 41% of the patients were without homologous transfusion. Intraoperative and postoperative autotransfusion technique is effective and dilutional autotransfusion is also a relatively effective method to reduce homologous transfusion.     

The newer microsurgical techniques in neurosurgery

The application of microsurgical techniques to neurological surgery has changed the treatment of several important neurological and neurosurgical diseases. Microsurgical decompression of the 5th and 7th nerves for trigeminal neuralgia and hemifacial spasm has become established as an accepted and effective technique. Application of the newer microvascular techniques in neurological surgery has increased the number of patients for whom surgical correction is possible and has, additionally, revolutionized the treatment of giant intracerebral aneurysms.     

Nail-Splinting Technique for Ingrown Nails: The Therapeutic Effects and the Proper Removal Time of the Splint

BACKGROUND: An ingrown nail is a common disorder that occurs most frequently in the great toe and causes much discomfort in patients. Although many therapeutic methods have been described, most of them can lead to severe damage to the nail or to frequent relapses. The nail-splinting technique is known to be a noninvasive therapeutic method for treating an ingrown nail. OBJECTIVE: Our purpose was to access the recurrence rate of the nail-splinting technique and to determine the proper removal time of the splint from the ingrown nail. METHODS: Fifty-seven patients with ingrown nail were treated with the nail-splinting technique. Subjects were randomized into two groups. For group 1 (28 patients), the splint was removed splint 3 days after treatment, whereas for group 2 (29 patients), the splint was removed splint 2 weeks after treatment. All patients underwent a follow-up examination at 1, 2, and 4 weeks after treatment and were evaluated for tissue status and level of pain. After 1 year, we evaluated the rate of recurrence by means of a telephone interview with each patient. RESULTS: A low recurrence rate (8.7%) for the nail-splinting technique was observed in both groups (7.1% in group 1 vs. 10.3% in group 2). The tissue status and level of pain were found to improve with time, with no statistical significance between the two groups (P> 0.05). CONCLUSION: This study indicates that the nail-splinting technique constitutes a very simple and effective, noninvasive therapeutic method for treating ingrown nail. We suggest that the 3-day nail-splinting technique is the most useful when the nail is intact or has only a slight defect.     

The combined spinal-epidural technique

Epidural and spinal blocks are well-accepted regional techniques, but they have several disadvantages. The CSE technique can reduce or eliminate the risks of these disadvantages. CSE block combines the rapidity, density, and reliability of the subarachnoid block with the flexibility of continuous epidural block to extend duration of analgesia. The CSE technique is used routinely at many institutions, particularly for major orthopedic surgery and in obstetrics. It has been used in tens of thousands of patients without any reports of major problems. Although at first sight the CSE technique appears to be more complicated than epidural or spinal block alone, intrathecal drug administration and siting of the epidural catheter are both enhanced by the combined, single-space, needle-through-needle method. Concerns about the epidural catheter entering the theca via the small puncture hole are now considered to be unfounded, but as with all epidural catheter techniques, vigilant monitoring of the patient during and after any injection is paramount. CSE is an effective way to reduce the total drug dosage required for anesthesia or analgesia. The intrathecal injection achieves rapid onset with minimal doses of local anesthetics and opioids, and the block can be prolonged with low-dose epidural maintenance administration. In addition, the sequential CSE method can be used to extend the dermatomal block with minimal additional drugs or even saline. Reduction in total drug dosage has made truly selective blockade possible. Many studies have confirmed that low-dose CSE with local anesthetic and opioid, or low-dose epidural block alone, will provide effective analgesia with minimal motor and proprioceptive block. Such neurologic selective blockade has made it possible for most patients to walk and bear down normally in labor or postoperatively. There remains concern about the risk of infection being increased when the CSE technique is used in place of epidural block alone. Despite a recent flurry of reports of meningitis with CSE procedures, there is no evidence the CSE block is more hazardous than epidural or subarachnoid block alone. Arguably, the single-space, needle-through-needle CSE technique will continue to improve with new needle designs and other advances to improve further the success rate and reduce complications, such as neurotrauma, PDPH, and infection. Over the past decade it has become clear that the CSE technique is a significant advance in regional blockade.     

Novel techniques in sentinel lymph node mapping and localization of nonpalpable breast lesions: The moffit experience

The concept of lymphatic mapping has helped to redefine the clinical significance of lymph nodes with respect to breast cancer. The combination technique using both blue dye and radiocolloid is the most effective method of lymphatic mapping. The data in the literature support the concept that all patients undergoing lympectomy or especially mastectomy should undergo lymphatic mapping if a diagnosis of invasive cancer is remotely possible. The low morbidity, high sensitivity, and specificity of mapping indicate its use for increasing number of patients thought initially not to be candidates for the procedure.     

Laparoscopic feeding jejunostomy: also a simple technique

Summary Placement of feeding tubes is a common procedure for general surgeons. While the advent of percutaneous endoscopic gastrostomy has changed and improved surgical practice, this technique is contraindicated in many circumstances. In some patients placement of feeding tubes in the stomach may be contraindicated due to the risks of aspiration, gastric paresis, or gastric dysmotility. We describe a technique of laparoscopic jejunostomy tube placement which is easy and effective. It is noteworthy that this method may be used in patients who have had previous abdominal operations, and it has the added advantage of a direct peritoneal view of the viscera. We suggest that qualified laparoscopic surgeons learn the technique of laparoscopic jejunostomy.     

The management of gastric outlet obstruction secondary to inoperable cancer

BACKGROUND: Historically, the distressing symptoms of malignant gastric outlet obstruction have been best managed by open gastrojejunostomy. We provide an assessment of an alternative laparoscopic technique. METHODS: We reviewed eight patients undergoing laparoscopic gastrojejunostomy. Patient data included age, sex, operation time, morbidity and mortality, length of stay, and outcome at 6 months where possible. RESULTS: There were six men and two women, their median age was 67 years. Median operating time was 135 min, median time to solid food was 4 days, and median postoperative stay was 7 days. Seven of our eight patients were palliated successfully using this technique. CONCLUSION: The risks inherent in operating on these patients, who are by definition in a poor state of health, has encouraged much interest in minimal access surgery. We conclude that laparoscopic gastrojejunostomy provides effective palliation of gastric outlet obstruction, and we recommend further evaluation of this technique.     

Clinical experiences with low intensity direct current stimulation of bone growth.

Low intensity direct current stimulation of bone growth involves the continuous application of cathodic currents in the nanoampere range. The technique has been applied to 13 patients with a variety of non-unions and pseudarthroses with a success rate of 77 per cent. Preliminary data indicate that a range of total energy, from 0.6 to 2.5 Joules, is maximally effective. The technique has been combined with anodic control of local bacterial infection with promising results. Both the osteogenic stimulation and the bacterial suppression techniques as described in this paper, appear to be safe and effective.     

专业化牙齿清洁(PMTC)技术

目的:通过文献回顾对专业化牙齿清洁技术(PMTC)的特点进行评价。方法:通过对近年来发表的有关PMTC的文献进行回顾性分析,评价PMTC技术的发展及临床应用。结果:PMTC已被证实可以有效祛除牙斑。由口腔专业人员实施的PMTC可以明显降低牙齿龋坏的发生,并可减少由于口腔细菌感染引发的全身疾病。PMTC技术由于诸多优点,已作为一项新技术在世界许多发达国家广泛开展,成为口腔保健治疗的重要手段。结论:PMTC技术是一项重要的口腔治疗技术,将在我国口腔保健美容医疗中具有广阔的应用前景。     

The patulous eustachian tube: management options.

The patulous eustachian tube is a benign, yet annoying condition that may be over-looked or misdiagnosed. It is frequently associated with peritubal atrophy, and usually responds to conservative measures such as weight gain or mucus-producing agents. In patients not responding to these measures, a variety of surgical options are available. We have been using a technique that avoids elevating a tympanomeatal flap, is reversible, and is effective. This technique, as well as other surgical options, are reviewed. The advantages and disadvantages inherent in them are discussed.     

腹横肌平面阻滞在腹部手术术后镇痛中的应用

背景 腹横肌平面（transversus abdominis plane block,TAP）阻滞技术是一项近几十年发展起来的新型的局部神经阻滞技术,它可以减少术后镇痛阿片类药物的用量,继而减少其相关副作用,提高患者总的满意度. 目的 介绍TAP阻滞技术,探讨其在腹部手术术后镇痛中的应用. 内容 就TAP阻滞的解剖基础、操作方法、临床效果、并发症及尚待解决的问题等方面进行综述,为临床研究及应用提供参考. 趋向 TAP阻滞技术,被证实在很多手术的术后镇痛应用中是安全、有效的,有着广阔的应用前景.     

The Maze procedure for the treatment of atrial fibrillation: a minimally invasive approach

OBJECTIVES: The standard Maze procedure has proven to be extremely effective in curing atrial fibrillation in thousands of patients worldwide. Until now it has required a median sternotomy and cardiopulmonary bypass. In order to simplify the standard approach, a minimally invasive technique was developed.We have recently applied this minimally invasive Maze procedure in 72 patients. METHODS: The technique is dependent on the use of cryosurgery and the total number of atriotomies has been decreased from twelve to four. In addition to performing the Maze procedure, 32% of patients have had concomitant surgery via the minimally invasive approach including mitral valve repair/replacement and tricuspid valve repair. RESULTS: Perioperative morbidity is improved following the minimally invasive approach in comparison to the standard approach with the incidence of temporary perioperative arrhythmias being decreased by 50%.The long-term recurrence of atrial fibrillation is 2.4% following the minimally invasive Maze procedure and 2.2% following the standard Maze procedure. The incidence of pacemaker requirements following the standard Maze procedure is 20% but only 6% following the minimally invasive Maze procedure. Both right atrial and left atrial transport function have been documented in 100% of patients following the minimally invasive Maze procedure. CONCLUSIONS: We believe that the minimally invasive Maze procedure is a substantial improvement over the standard approach in terms of patient morbidity while preserving the effectiveness of the Maze procedure in curing atrial fibrillation.     

The vacuum chest wall lifter in the treatment of pectus excavatum

Since 2002, the Eckart Klobe vacuum has been used in our Service as an innovate and non-invasive procedure in patients with pectus excavatum. This vacuum method contributes not only to hold promise as a valuable adjunct in minimally invasive surgery, but also as an effective method to lift and fix the funnel for repairing pectus excavatum in some patients. Our experience is limited to the use of this device in 10 patients, during the Nuss technique. This procedure has been useful for safer passage of the introducer, and as a definitive treatment in a 10 years old girl with pectus excavatum and a Haller index of 5.1 with successful result after one year of treatment. The aim of this study is to report the safety and efficacy of this procedure in appropriate patients. Long-term results will be necessary to confirm this method as an alternative to more invasive techniques.