The treatment of prominent ears: A 25-year survey of the island technique

The authors report on a 25-year retrospective study of 488 cases of prominent (protruding) ears corrected by the island technique of Pitanguy.     

Prominent ears and their correction: A forty-year experience

The technique described in this article correcting the protruding ear deformity has evolved over 40 years. The original procedures and our subsequent modifications are described, including 20-year followup results. The possible pitfalls in carrying out this procedure and how to avoid them are also described. A relatively standardized short procedure with minimal morbidity and maximum long-term results yields an aesthetically satisfactory looking ear.     

Otoplasty using a spherical metal head dermabrador to form a retroauricular furrow: Five-year results

Since 1987 we have performed more than 300 otoplasties using a combined technique, i.e., furrowing the cartilage retroauricularly with the dermabrasion tool with a spherical metal head, followed by vertical mattress sutures. To undertake a retrospective study (subjective results), we sent a questionnaire to 267 patients (100%) who underwent surgery a minimum of one year prior (average 2.53 years). One hundred sixty-seven forms were returned (63%) and the case sheets of these patients were collected. To objectify the results, 102 patients (38.6%) were drafted and 38 (14.3%) could be controlled. By reviewing the literature, where only a few long-term surveys could be found, an analysis of long-term results was performed. Both the subjective findings and the objective results showed a successful operative outcome and proved that by using this combined technique a far better result can be obtained than with most other techniques.Presented at the 30th annual meeting of the Austrian Society for Plastic, Aesthetic and Reconstructive Surgery, Vienna, Austria, October 15–17, 1992     

The Effects Of Colostomy On The Quality Of Life In Patients With Spinal Cord Injury: A Retrospective Analysis

Abstract

Purpose: The purpose of this study was to evaluate the effects of colostomy on the quality of life (QOL) in patients with spinal cord injury (SCI) by designing a questionnaire that used self-reported data and correlating these data with the clinical information obtained from patients' medical records.

Materials and methods: A comprehensive QOL questionnaire was designed to specifically address the following 5 domains: physical health, psychosocial adjustment, body image, self-efficacy, and recreation/leisure. This questionnaire was completed during a telephone or an in-person interview. The subjective data derived from the questionnaire were correlated with objective medical information obtained from a review of medical records.

Results: The QOL improved significantly (t = 9.128, P < .0001) after colostomy. All 27 (100%) patients were “satisfied,” and 16 (59%) of them were “very satisfied” with colostomy. Nineteen (70%) patients would have preferred to have the colostomy done earlier, and only 3(11%) patients wished it reversed. Colostomy reduced the number of hospitalizations caused by chronic bowel dysfunction by 70.4%. After colostomy, the average amount of time spent on bowel care was reduced from 117.0 min/day to 12.8 min/day (t = 7.964, P < .0001). All patients stated that colostomy simplified bowel care routine and increased independence. Significant improvements were recorded in the areas of physical health, psychosocial adjustment, and self-efficacy. Stoma prolapse and wound dehiscence were the most common complications of stomal surgery. When compared with medical data, patients were able to reliably recall average time with bowel problems (r = .881, P < .0001) and stomal surgery complications (r = .810, P < .0001).

Conclusion: Colostomy is a safe and effective treatment for chronic bowel dysfunction in patients with spinal cord injury. It is well accepted by the patients and significantly improves QOL and bowel management procedures. Correlation analysis indicates that subjective patient-reported data are consistent with objective data obtained from the medical records.     

Retrospective Analysis of Laparoscopic Gastric Banding Technique: Short-term and Mid-term Follow-up

Background: Although adjustable gastric banding shows good results concerning weight loss, several complications such as excessive vomiting, total dysphagia, and slipping of the stomach through the band with pouch dilatation may occur rather frequently. Different types of adjustable bands are available to prevent these short- and mid-term complications. Methods: In this retrospective study, 120 consecutive laparoscopic adjustable gastric bandings were performed. In group I, 50 patients were treated with adjustable silicone gastric banding (ASGB) by an intragastric balloon calibration technique. Group II (n = 29) received the same band by a surgical technique with tunneling behind the esophagus toward the angle of His. Group III (n = 41) received Swedish adjustable gastric banding (SAGB) by the same technique as in Group II. Results: Weight loss was approximately 15% of the excess weight after 3 months, 30% after 6 months, and 45% after 12 months in all groups. Total dysphagia was significantly more frequent in Groups I and II. The incidence of slipping of the band and pouch dilatation was more frequent in Group II. Conclusion: The diameter of the ASGB band is rather small and can cause total dysphagia independently of surgical technique. The SAGB is easy to perform and seems less vulnerable to complications like dysphagia and slipping of the band, probably because of the individual adjustment of the stoma diameter during surgery and good fixation of both band and ventral pouch with separate posterolateral sutures.     

放射治疗流程再造及质量控制

目的对放射治疗流程进行再造与优化并对放射治疗的各个环节进行全面质量控制,使放射治疗的效率提高、差错率降低。方法通过对放射治疗各环节进行分析,对放射治疗流程进行再造。结果实施放射治疗流程再造及质量控制后,每月工作量与上年同期对比增长60%,放射治疗综合满意度提高了25.8%。结论放射治疗流程再造及质量控制,可以使放射治疗的效率提高、差错率降低。     

Quality of Life After Ileoanal Pouch: A Comparison of J and W Pouches

Introduction  Standard treatment for ulcerative colitis and prevention of malignancy is total proctocolectomy with a neoileal pouch. The ideal configuration of the pouch has been debated. We hypothesized that there was no difference in quality of life between the J pouch and the W pouch. Material and Methods  We retrospectively reviewed the medical records of all patients undergoing ileoanal anastomosis with pouch construction at a single community-based teaching hospital over an 11+-year period. We collected demographic, operative, and postoperative data and then developed and distributed a survey designed to assess patient quality of life following pouch construction. The data of patients who had J pouches were then compared with those of patients who had W pouches. Forty-nine patients were identified; 30 had J pouches and 19 had W pouches. Results  The groups did not differ significantly in age, sex, or indication for surgery. Significant differences were detected in readmission rates (J = 63%, W = 21%; p = 0.004) and length of follow-up (J = 61 months, W = 117 months; p = 0.001). Complication rates, length of stay, and conversion to end ileostomy rates were similar between groups. Self-reported health status, activity restrictions, urgency, seepage, protective pad use, and number of bowel movements at night were also similar. A significant difference existed in number of bowel movements per day (J = 6, W = 4.5, p = 0.041). No difference in quality of life was found between groups. Subgroup analysis of ulcerative-colitis-only patients had no effect on results. Conclusion  Because the J pouch is less technically demanding, it should be the preferred configuration.     

Effect of Smoking on Postoperative Function and Quality of Life After Full Thickness Arthroscopic Rotator Cuff Repair: A Retrospective Analysis

PurposeThe effect of smoking on preoperative and postoperative outcome scores as well as quality of life measurements after arthroscopic rotator cuff repair (ARCR) has not been fully understood, and studies regarding this are lacking in the literature. This study aimed to evaluate the effect of smoking on function and quality of life after ARCR.MethodsTwo-hundred patients who underwent full-thickness ARCR with a minimum 1-year follow-up period were included and evaluated retrospectively. The patients were divided into two groups: smokers (Group 1, 59 patients) and nonsmokers (Group 2, 141 patients). Pre- and postoperative Constant Murley (CM) scores, American Shoulder and Elbow Surgeons (ASES) scores, visual analogue scale scores (VASs), and Short-Form 36 health survey (SF-36) scores were used to evaluate functional and quality of life outcomes. The correlation between the smoking amount (pack-years) and outcomes was evaluated.ResultsA total of 200 patients included into study (90 male and 110 female) with mean age of 62.68 ± 3.98. There was no statistically significant difference between the two groups regarding preoperative scores, except in the ASES score (P = 0.021) Additionally, there was a statistically significant difference between the groups regarding postoperative CM score, ASES score, and VAS, and in physical functioning and role limitations due to physical health domains of the SF-36 (P = 0.029, P = 0.038, P = 0.021 and P = 0.020, respectively). There were small to moderate negative correlations between amount of smoking and preoperative physical functioning, role limitations from emotional problems, energy/fatigue, emotional well-being, and pain domains of the SF-36. However, there were moderate to strong negative correlations between amount of smoking and postoperative SF-36 domains.ConclusionPreoperative and postoperative functional outcome scores, and quality of life measurements are negatively affected from smoking. As the amount of smoking increases, postoperative results are negatively affected.Level of evidence3.     

Quality of Life and Functional Long-Term Outcome After Partial Pancreatoduodenectomy: Pancreatogastrostomy Versus Pancreatojejunostomy

Background To determine the effects of pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) as types of reconstruction after partial pancreatoduodenectomy on postoperative quality of life and long-term gastrointestinal morbidity, the outcomes of 104 patients (PG, n = 63; PJ, n = 41) were evaluated.Methods To compare the two groups, the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (QLQ-PAN 26) standard and an additional self-developed questionnaire were used. The mean time after surgery was 6.4±3.4 years.Results In the PG group, there was a significant reduction of gastric acid reflux, gastroduodenal ulcers, and pain compared with before surgery. However, a significant increase in steatorrhea, intolerance toward larger meals, and aversion against certain foods were observed. In the PJ group, no significant change of preoperative symptoms was present except for jaundice. The incidence of diabetes mellitus and the need for pancreatic enzyme substitution had increased significantly but similarly in both groups. The global quality of life was identical in both groups of patients.Conclusions This analysis demonstrates that the global quality of life was not affected by the type of reconstruction after partial pancreatoduodenectomy. Patients who underwent PG had a significant reduction of gastric reflux, pain, and abdominal discomfort compared with before surgery. Patients in both groups showed an impaired exocrine and endocrine pancreatic function of a similar extent.     

活血软肝丸的制备及质量控制

目的研制活血软肝丸并制定质量控制方法。方法将柴胡、郁金、牡丹皮、血竭等药材粉碎成细粉,泛制成水丸。采用显微鉴别、薄层色谱法定性鉴别及高效液相色谱法测定主要成分柴胡皂苷a的含量。结果制备的丸剂均匀、崩解好,显微鉴别专属性强,薄层色谱鉴别无干扰,柴胡皂苷a线性范围为0.1～1.6μg,平均回收率为98.5%,RSD为0.49%,n=6。结论制备方法简便,质量控制准确快速,能较好控制本品质量。     

Comparison of the Complication Incidence in Open Versus Endoscopic Gastrocnemius Recession: A Retrospective Medical Record Review

Gastrocnemius recession is a practical and effective procedure to address gastrocnemius equinus. It has been shown that an equinus deformity can lead to the development of plantar fasciitis, osteoarthritis, and foot ulcerations. The 2 approaches to gastrocnemius recession are open and endoscopic. Both are viable options; however, both also have associated complications. We compared and evaluated the postoperative complications associated with these procedures. The electronic database of our orthopedics division at the University of Florida College of Medicine, Jacksonville, was retrospectively searched to identify all cases of gastrocnemius recession (Current Procedural Terminology [CPT] code 27687), and unlisted arthroscopy (CPT code 29999) from February 2006 to February 2016. The difference in the outcome variable, the incidence of postoperative complications, was assessed using Fisher's exact test. A total of 39 patients (41 procedures) were in the open gastrocnemius recession group and 35 (39 procedures) were in the endoscopic gastrocnemius recession group. The median follow-up time was shorter in the open gastrocnemius recession group than in the endoscopic gastrocnemius recession group (9 versus 12 months; p?<?.001). Postoperative complications developed after 12 of the 80 procedures (15%), with a greater incidence after open than endoscopic procedures (26.8% versus 2.6%; p?=?.003). The complications associated with the open technique included 1 case of scar pain (2.4%), 5 of dehiscence (12.2%), 1 of infection (2.4%), 2 of calf abscess (4.9%), and 2 cases of nerve injury (4.9%). A single complication occurred with the endoscopic technique—1 case of dehiscence (2.6%). To the best of our knowledge, ours is the first study to compare the postoperative complications between these 2 techniques. We found the incidence of postoperative complications was significantly lower in the endoscopic group, emphasizing the benefit of using the endoscopic approach. These findings could prove invaluable when addressing gastrocnemius equinus in those with a greater risk of postoperative complications.     

Surgical Education to Improve the Quality of Patient Care: the Role of Practice-Based Learning and Improvement

Health care is going through immense change, and concerns regarding the quality of patient care and patient safety continue to be expressed in many national forums. A variety of stakeholders are demanding greater accountability from the health care profession. Education is key to supporting surgeons’ efforts to provide high-quality patient care during these challenging times. Educational programs for surgeons should be founded on principles of continuous professional development (CPD) and practice-based learning and improvement (PBLI). CPD focuses on the specific needs of individual surgeons and involves lifelong learning throughout a surgeon’s career. It needs to form the basis of PBLI efforts. PBLI involves a cycle of four steps—identifying areas for improvement, engaging in learning, applying new knowledge and skills to practice, and checking for improvement. Ongoing involvement in PBLI activities to address specific learning needs should positively impact a surgeon’s practice and improve outcomes of surgical care.     

Outcomes and Material Cost Comparison of Transosseous Versus Suture Anchor Fixation of the Achilles Tendon: A Retrospective Study

Insertional Achilles tendinopathy is a common pathology that may be resistant to conservative treatment requiring surgical intervention. Treatment often involves partial to complete detachment of the Achilles tendon, debridement, and reattachment. Although 50% of the tendon may be safely resected without significantly compromising strength, the addition of a lengthening procedure requires further reinforcement. We conducted a retrospective review of 43 procedures comparing outcomes of 16 single suture anchor procedures with 27 transosseous fixation procedures for reattachment of the Achilles. The suture anchor group utilized one of 2 different industry anchors while the transosseous group utilized sutures ranging in size from 2-0 to #2. Female patients contributed 67% of the procedures with 53% occurring on the left side. For each group the median preoperative pain score (scale 0-10) was 8 and the median of the lowest reported postoperative pain score was 0. The typical time to lowest postoperative pain was 10 weeks for the suture anchor group and 4 weeks for the transosseous group. Tourniquet time averaged 59.3 (12.9) minutes for the suture anchor group and 65.1 (16.4) for the transosseous group. There was a large difference in material costs between the suture anchor and transosseous groups which ranged from $364.51 to $448.51 and $99.80 to $104.00 respectively. With similar results on postoperative pain and adverse event rate to suture anchor fixation and lower material costs than anchor fixation, transosseous fixation remains a viable option for fixating the Achilles tendon to bone in treatment of insertional Achilles tendinopathy.     

急诊青木春夫式断流术治疗胃底、食管静脉曲张破裂出血--附31例报告

目的　总结急诊青木春夫式断流术治疗胃底、食管静脉曲张静脉破裂出血的效果。方法　对 3 1例行急诊青木春夫式断流术的患者临床资料进行回顾性分析。结果　急诊手术止血率10 0 %。本组手术死亡 1例 ( 3 .2 % ) ,早期术后并发症发生率 9.7% ,均经非手术治愈。 2 8例获远期随访 ( 3个月 -5年 )。其中死亡 1例 (占随访数的 3 .6% ) ;门脉高压性胃病 9例 (占随访数 3 2 .1% ) ;未见再出血。结论　本术式操作简单、安全可靠 ,疗效满意 ,并发症少 ,是基层医院治疗门脉高压胃底、食管下段静脉曲张破裂大出血的理想术式。     

The Value of a Mortality-scoring System in the Quality Control of Patients Undergoing Abdominal Aortic Surgery

OBJECTIVES: to assess the quality of care of patients undergoing abdominal aortic surgery. MATERIALS: three hundred and forty-six patients undergoing surgery for aneurysmal or occlusive disease of whom 51 died. METHODS: we developed a mortality registration system to classify causes of death, to evaluate shortcomings in treatment, and to determine the extent of agreement between clinical diagnosis and necropsy findings. RESULTS: the main cause of death for 11 patients (22%) was a poor clinical condition at admission, while 76% (n=39) of the patients died due to postoperative complications. Myocardial infarction was the most frequently encountered complication. Deficiencies in medical treatment were observed in 10 of the 51 deaths (20%). Autopsy was performed in 33 of the 51 patients (65%), revealing in 10 cases (30%) a major discrepancy between pre- and postmortem findings. Six of the 10 autopsies revealed that a myocardial infarction had been missed during the postoperative period. CONCLUSIONS: autopsy reports are essential for accurately estimating complication rates as we observed discrepancies in 30% of cases.     

腹腔镜与开放手术治疗上尿路移行上皮肿瘤的远期疗效比较

目的：比较后腹腔镜下与开放性肾、输尿管及膀胱袖状切除术治疗上尿路移行上皮肿瘤的远期临床疗效。方法：回顾性分析48例行后腹腔镜下肾、输尿管及膀胱袖状切除术及55例行开放性肾、输尿管及膀胱袖状切除术患者的临床资料,比较两种术式术中、术后各种参数的差异。结果：后腹腔镜组与开放手术组患者在性别、年龄、肿瘤位置、及肿瘤分期上的差异无统计学意义。后腹腔镜组在术中估计出血量、术后住院时间等方面明显优于开放组（P〈0．05）。术后平均随访26．4个月,后腹腔镜组与开放组总生存率分别为79．17％、85．19％,疾病特异生存率分别为91．67％、94．44％,组间差异均无统计学意义（P〉0．05）。两组无瘤复发生存率分别为79．17％、72．22％,两组膀胱无复发生存率分别为79．17％、79．63％,组间差异均无统计学意义（P〉0．05）。结论：与传统开放手术相比,后腹腔镜下手术具有出血少、创伤小、患者痛苦少、恢复快、住院时间短等特点,并且二种手术方式具有相同的远期疗效。     

腹腔镜全直肠系膜切除保肛术后生活质量评估

目的对低位直肠癌患者行腹腔镜全直肠系膜切除保肛术(LTME ASP)后的生活质量进行评估。方法以2001年6月至2004年3月期间在四川大学华西医院直肠癌治疗组行LTME ASP的125例低位直肠癌患者为研究对象(LTME组),同期103例行开腹全直肠系膜切除保肛术(OTME ASP)的患者作为对照(OTME组),采用国际标准问卷QLQ-C30和QLQ-CR38,分别于术后3～6个月、12～18个月、>24个月3个时段进行前瞻性调查。结果LTME组的躯体功能、性功能及性快感分别在第1、2、3时段显著优于OTME组。两组女性性障碍差异无统计学意义,而LTME组在第1、2时段的排尿障碍和第2时段的男性性障碍均显著轻于OTME组。从第1时段到第2时段,两组的角色功能、认知功能、社会功能、未来期望、整体印象、疲乏、恶心呕吐、疼痛、失眠、厌食、腹泻、化疗副反应、排便障碍、消瘦以及LTME组的性功能、排尿障碍和男性性障碍均显著改善;而两组的性快感以及OTME组的性功能则在第3时段显著改善。结论LTME ASP治疗低位直肠癌可获得优于开腹手术的术后生活质量,其优势主要体现在躯体功能、排尿障碍、性功能、性快感、男性性障碍等方面,而以上优势主要存在于术后中、短期;LTME组和OTME组术后患者的生活质量均随时间延长趋于好转,术后1年最为显著,LTME组术后的排尿障碍和性功能比OTME组术后恢复快。