Subpectoral and precapsular implant repositioning technique: correction of capsular contracture and implant malposition

Background  

Although capsule formation is a natural-healing process following breast augmentation using implants, a contracted capsule around a poorly positioned implant can act as an obstacle during the corrective procedure to reposition the implant. The ideal treatment of capsular contracture is removal of the capsule and covering the implant with a healthy envelope without scar tissue. However, total capsulectomy in the submuscular space may be difficult, especially if the capsule is firmly attached to the chest wall. This situation may require a highly skilled technique because aggressive capsulectomy could injure the intercostal muscles and vasculature and cause further complications such as pneumothorax. Therefore, the authors have developed a new, less traumatic method of leaving the capsule behind the new implant.     

A closed technique for repositioning dislocated iris plane lenses

Of 450 iris plane IOL's implanted over a 3 1/2-year period, 20 (5%) dislocated. Four of these lenses dislocated into the vitreous and were either floated or surgically reoriented into the anterior chamber to give final visual acuities of 20/30 or better. Sixteen lenses dislocated into the anterior chamber and were repositioned using a closed bimanual technique. After lens repositioning, eighteen eyes achieved 20/30 or better vision. One eye's vision was 20/200 and another case had finger-counting vision.     

Simplified chest tube removal: a new technique

There is a simple method to remove chest tubes using a transparent adhesive dressing. The dressing provides an inexpensive, comfortable, waterproof, and secure air-tight seal and also allows visualization of any drainage.     

Single-docking robotic-assisted nephroureterectomy and extravesical bladder cuff excision without intraoperative repositioning: The technique and oncological outcomes

Background/Objective: Currently there are few report of oncologic outcomes following robotic-assisted radical nephroureterectomy (RRNU) based on long-term follow-up. To evaluate the therapeutic effect of RRNU for upper tract urothelial carcinoma (UTUC), a technique of single-docking RRNU was described and its oncological outcomes was evaluated.Patients and methodsThe data of 29 patients underwent RRNU for UTUC of Ta-T3 from July 2013 to June 2016 was analyzed. The data of 131 patients of UTUC underwent laparoscopic radical nephroureterectomy (LRNU) over the same period was analyzed as control. Kaplan-Meier analysis and Cox regression were used for prognosis evaluation.ResultsThe median follow-up time was 40.5 and 40.4 months in RRNU cohort and LRNU cohort. No difference in 5-year intravesical recurrence-free survival (IVRFS) (88.0% vs. 85.5%, p = 0.611) or distant metastasis-free survival (93.1% vs.96.7%, p = 0.323) between RRNU cohort and LRNU cohort. The 5-year retroperitoneal recurrence-free survival and cancer-specific survival (CS) were lower in RRNU cohort than in LRNU cohort (77.3% vs. 87.7%, and 71.2% v.s. 84.7%, respectively).ConclusionThe single-docking RRNU is an effective treatment for UTUC, avoiding the re-docking of patient-side cart or the intraoperative reposition of patient, and bringing equivalent 5-year IVRFS compared to LRNU. However, the lower 5-year retroperitoneal recurrence-free survival and CS in RRNU cohort warned the concern of higher chance of local tumor spillage during RRNU. The noninferiority of RRNU to LRNU still needed the confirmation of large sample sized, prospective randomized controlled study.     

微型泪道内镜诊治泪道疾病患者的护理

对128例(146眼)泪道痰病患者采用微型泪道内镜直视下检查,并同时配合激光、微型电钻等进行治疗,结果术后随访1～6个月,治愈117眼,好转19眼.无效10眼.提出术前的心理护理及健康教育有助于患者了解治疗方法、建立治疗信心,术中与术者密切配合,术后对患者的正确指导是保证治疗成功的重要内容.     

Early postoperative assessment technique: a time-to-remission technique after condylar replacement

Inconsistencies in reports of clinical outcome occur on many levels. Using life-table techniques for remission can increase reproducibility, facilitate comparisons with other studies, and answer patient questions about rehabilitation time. The complementary rate of Kaplan-Meier's cumulative survival rate was calculated for pain and knee mobility after unicondylar and bicondylar knee replacement in osteoarthritis and rheumatoid arthritis. Pain relief was quick, often within 2 months. Eventually, >50% had attained both pain alleviation and normal mobility. The probability of regaining at least 90 degrees flexion was greater than regaining 0 degrees extension. The probability of increasing the preoperative extension capacity was higher than that of increasing the flexion capacity.     

Accurate femur repositioning is critical during intraoperative total hip arthroplasty length and offset assessment

Techniques for intraoperative leg length equalization are based on measurements between fixed points on the pelvis and femur. These techniques have not been reliable because they are based on accurate femur repositioning. We examined the error that results from inaccurate femur repositioning during total hip arthroplasty. Total hip arthroplasty was simulated on a calibrated test bench and changes in leg length and femoral offset were measured. Before dislocation, the femur was held in neutral alignment. Total hip arthroplasty was simulated without changing length or offset and the femur was returned to neutral. Length and offset changes were measured with the femur held in 5 degrees and 10 degrees of abduction/adduction and flexion/extension. Five degrees of abduction/adduction malpositioning caused 8 mm of apparent change in leg length. Errors in femoral offset followed a similar trend. When using common techniques for intraoperative leg length equalization and offset restoration, inaccurate abduction/adduction repositioning of the femur with respect to the pelvis can cause substantial errors in the measurement of length and offset change.     

Adding or repositioning intracranial electrodes during presurgical assessment of neocortical epilepsy: electrographic seizure pattern and surgical outcome

OBJECT: The aim of this study was to investigate changes in electroencephalography (EEG) patterns obtained from added or repositioned electrodes after those initially implanted had failed to indicate the true local ictal onset zone. The authors focused on the following matters: rationale for adding or repositioning electrodes, topographic and frequency characteristics of ictal onset before and after adding or repositioning electrodes, the effect of the procedures, and the relationship between changes in intracranial EEG onset patterns and surgical outcomes. METHODS: Of 183 patients with intracranial recordings, 18 experienced repositioning of existing or implanting of additional electrodes 7 or 10 days later. All patients underwent resection and were followed up for more than 1 year. In particular, the relationship between surgical outcome and distribution/frequency of intracranial seizure onset was analyzed. Results of noninvasive presurgical evaluations in patients who had undergone single and double invasive studies were also evaluated. By adding or repositioning electrodes, a new ictal onset zone was revealed in 13 patients. In another four, the second evaluation led to a change in defining the resection margin. Ictal onset in the partially sampled area, simultaneous or independent onset in two separate areas, and onset in the distal end of the electrode strip or grid were common reasons for failing to localize the ictal onset zone during the initial evaluation. Seven of 11 patients who were ultimately found to have a focal ictal onset zone on the second evaluation became seizure free after the operation. Only one of six patients with a regional ictal onset zone identified on the second evaluation became seizure free. There was no relationship between the frequency of the ictal rhythm and surgical outcome. Note, however, that surgical outcome was more favorable in patients who had undergone a single invasive study than in those who had undergone double invasive studies. The patients who needed a second evaluation had less localizing information and less concordant results on presurgical evaluations. When comparing nonlesional cases, surgical outcomes were not significantly different among patients with a single invasive study and those with double invasive studies. No additional morbidity or death occurred during the second study. CONCLUSIONS: The addition or reposition of intracranial electrodes with a short-term interval should be considered in selected patients. Spatial restriction of the ictal onset rhythm identified on repeated evaluation is the most important predictor of a good surgical outcome.     

右侧卧位联合生理盐水快速推注助空肠管复位

目的 研究空肠营养管部分脱出后的重置方法.方法 对15例肠内营养支持发生空肠营养管脱出的患者,采取右侧卧位联合生理盐水推注的方法复位.结果 脱出的部分空肠营养管平均约5.5 min成功重置,X线摄片显示空肠营养管均进入预定位置.结论 右侧卧位联合盐水快速推注助空肠营养管复位,安全、有效、操作简便、费用低廉.     

Radial artery harvest: comparison of ultrasonic dissection with standard technique

BACKGROUND: The radial artery (RA) is used increasingly for myocardial revascularization. Having an ultrasonic dissector available in our unit, we began to use it for RA harvest with the impression that harvest spasm might be less for the new technique. METHODS: We compared RA harvest using standard techniques (21 RA) with ultrasonic dissection (41 RA) in which all branches were divided between clips with scissors in the former and bleeding branches were clipped in the latter. RESULTS: Harvest times were not different. Conventional technique used 74+/-18 (mean +/- standard deviation) clips versus 3.2+/-4.3 clips (p<0.001). In situ free flow was 17.2+/-20.7 mL/min for conventional technique versus 52.5+/-48.1 for ultrasonic (p<0.001). Free flow after the proximal anastomosis to the left internal thoracic artery was 38.5+/-60.4 mL/min for conventional technique and 50.7+/-29.6 for ultrasonic (p = 0.008). Free flow 10 minutes after intraluminal papaverine was 78.5+/-45.9 mL/min for usual technique versus 102.8+/-51.7 for ultrasonic (p = 0.016). No patient required reoperation for bleeding. CONCLUSIONS: Ultrasonic dissection of the RA is associated with decreased RA spasm, good hemostasis, no additional harvest time, and has become our standard technique.     

Lower blepharoplasty: transconjunctival fat repositioning

Traditionally, lower eyelid herniated fat is removed, which may cause a sunken or hollow lid appearance, especially in patients with a tear-trough deformity (nasojugal groove). Lower eyelid transconjunctival fat repositioning, defined as the subperiosteal repositioning of the medial and central lower eyelid herniated orbital fat into the nasojugal fold, may prevent the surgical hollow lower eyelid appearance while treating the herniated fat. Fat repositioning may be combined with an endoscopic subperiosteal midface-lift, transcutaneous skin pinch, and transconjunctival orbicularis oculi excision. This technique offers a powerful tool in the surgical armamentarium of the facial plastic surgeon.