Distal hypospadias: One-stage repair by triple-flap technique

A one-stage repair of the distal hypospadias based on the combination of the principles of the techniques of Ombredanne, Browne, and Byar is reported.     

The Shouldice Hospital technique

The Shouldice repair is used for all types of inguinal hernia whether indirect, direct, sliding, multiple, recurrent, male or female. Local anesthesia is given in more than 95% of cases. The repair is a modified Bassini. Essential preliminaries are accurate dissection at the internal ring with adequate treatment of any indirect hernia. The cremaster is excised. Accurate recognition and definition of the transversalis plane is routine and fundamental. Essentially the repair is an overlap of the divided transversalis plane utilising 4 lines of continuous monofilament stainless steel wire 34 gauge. Patients, ambulant immediately, stay in hospital 2-3 days postoperatively. A large personal series of more than 20,000 inguinal repairs performed almost exclusively in this hospital during a 30 year period from 1954 to 1984 is tabulated. Recurrence rates of less than 1% for repair of primary inguinal hernia and re-recurrence rates of 2-4% for repair of recurrent inguinal hernia are reported. Surgeons in other countries now employing this technique achieve comparable results, often using other non-absorbable suture material.     

The tumescent technique revisited

In the history of suction-assisted lipectomy, ultrasonic liposculpture and body contouring procedures, Klein's formula for the tumescent technique represents an important milestone. Since 1987 the formula has been altered by other clinicians. Although initially created for outpatient surgery without the services of an anesthetist, the technique is nowadays used so frequently that it cannot any longer be considered as a minor office procedure. It is useful to examine the ingredients of the various formula used in order to justify their use. This paper contains five sections. Part one deals with the fluid required by the various authors. Water and electrolytes exchanges in relation to the interstitial compartment are reviewed. Part two considers local anesthetics, their toxicity and the maximum safe dose. Part three considers the controversy on epinephrine. Part four comments on the addition of sodium bicarbonate to the solution. Part five explains why infiltration of chilled solutions is inappropriate. The following regimen is advised as a result of the above studies: lactated Ringer's solution is the fluid of choice; lidocaine: 500 mg/1 as the reference anesthetic. The maximum safe dose recommended for liposuction is 35 mg/kg over 45 min (PDR recommendations: 7 mg/kg). Epinephrine: 1 mg/1. Prospective studies ought to be done on the topic. Sodium bicarbonate 8.4%: 5 MEq/1 (optional). Higher doses are of no value but are not harmless. The fluids to be infiltrated at room temperature rather than chilled. Correspondence to: G.-F. Maillard     

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.     

The Lassus vertical technique

In this historical perspective article, the author outlines the evolution of his vertical scar technique, first developed in 1964. He describes the procedure and reports the results of his 42-year experience with a series of 2000 breasts.     

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.     

双极电外科技术-PKRP

经尿道前列腺等离子双极电切（PKRP）是良性前列腺增生新的手术治疗方式．其以生理盐水为灌洗液使手术更为安全,特殊的切割作用机理使手术出血更少．引起众多学者的注意。     

The reverse shoulder prosthesis--surgical technique

In this article, the surgical technique of the reverse shoulder prosthesis is described in detail. Indications for the procedure, difficulties encountered during surgery, and potential postoperative complications and their solutions are discussed.     

The open palm technique.

Dupuytren's disease presents a difficult problem that should not be treated casually. It is a continuing, unpredictable condition in which surgery is the only treatment available when contracture occurs. Surgery itself may cause an acceleration of the disease. Patients should be made aware that this is a continuing problem, often unpredictable in its course, with and without treatment. It is a pervasive disease, and when surgery is unsuccessful, the hand that underwent surgery may worsen. The open palm technique is a useful technique for avoiding complications in the early postoperative period. It is particularly useful in those patients with significant metacarpophalangeal joint contractures at more than one finger. The open palm technique does not affect the long-term outcome in these patients.