The crossover toe and valgus toe deformity

Second toe problems are among the most common of all forefoot complaints. Its proximity to the hallux combined with limited motion at the second tarsometatarsal joint likely contributes to the second MTP joint being the most common to experience both pain and deformity. Many causes have been linked to this problem, which has lead to many surgical techniques to correct this deformity. Although many techniques have been described, a systematic approach relying first on soft tissue releases and plication followed by osteotomies as necessary has lead to satisfactory outcomes in the treatment of this difficult problem.     

What are the symptoms of internal rectal prolapse?

Aim Although high‐grade internal rectal prolapse is believed to cause functional symptoms such as obstructed defaecation, little has been published on the exact distribution and frequency of symptoms. The aim of this study was to identify the most common symptoms of patients with high‐grade internal rectal prolapse. Method Patients were diagnosed with high‐grade prolapse (grade 3 and 4) on proctography using the Oxford Rectal Prolapse Grade. Information from a prospectively collected database was supplemented by a retrospective case note review. Results Eighty eight patients (94% of them women) were included for analysis. Faecal incontinence (56%) was the most common symptom at presentation. Symptoms related to obstructed defaecation syndrome were the next most common, including incomplete evacuation (45%), straining (34%), digital assistance (34%) and repetitive toilet visits (33%). Conclusion A variety of symptoms may be caused by high‐grade internal rectal prolapse Although symptoms of obstructed defaecation were frequent, urge faecal incontinence was the most common.     

Bilateral Areoleor Depigmentation After Augmentation Mammoplasty: A Case Report and Literature Search

Breast augmentation is by far one of the most common aesthetic procedures performed by plastic surgeons, and silicone implants are the most common prostheses used. Complications arising from the procedure are broadly categorized as either surgery or prosthesis related. Most of the complications are well known and have been documented, but areolar depigmentation after silicone gel prosthesis has not been reported to date.     

Bladder tumors in children

Our experience with bladder tumors in children is presented and the pertinent literature reviewed. Nonepithelial tumors are more common than epithelial ones, and the most common symptom is bladder outlet obstruction. Papilloma, the common epithelial tumor, usually presents with hematuria and is successfully treated by transurethral methods. Treatment of bladder neurofibroma will depend on the site and size of the tumor and on resultant symptoms and obstruction; small or moderate-size nodules may be amenable to transurethral resection, local excision, or segmental resection, but for diffuse involvement of the bladder, total cystectomy may be necessary. Hemangiomas are the most common benign connective tissue tumor, and their common location in the upper part of the bladder usually permits successful treatment by open excision or segmental resection. Rhabdomyosarcoma is the most common bladder tumor in children. On present evidence radical cystectomy is the treatment of choice. The contributions of adjunct radio- and chemotherapy are not well defined, but such treatment is recommended since it has contributed to the control of tumor in nonresectable cases. Four of 8 patients in this series are alive and well five and one-half to seventeen years, 3 having had radical cystectomy (with radiotherapy in 2 and chemotherapy in 1) and 1 segmental resection with radio- and chemotherapy. Leiomyosarcoma of the bladder has been controlled by segmental resection, but it is logical to believe that radical cystectomy would extend the possibilities of surgical control in some cases; adjunct irradiation and chemotherapy may deserve a place in treatment as well.     

Laparoscopic transduodenal papillosphincteroplasty

In the past 20 years, the approach to biliary lithiasis has changed tremendously as a result of advances in endoscopic and laparoscopic techniques. The two most important open surgical techniques involve extraction of the stones from the common bile duct combined with choledochoenterostomy and papillotomy followed by transduodenal papillosphinteroplasty. Ideally, the choledochotomy is followed by the insertion of a T-tube in the common bile duct. The transcystic approach has never been considered. The first endoscopic papillotomy was performed in 1973. Subsequently, it became the most widely used method for removal of common bile duct stones. In this report we explore the possibility of performing a laparoscopic transduodenal papillosphincteroplasty, following the strict rules commonly used in surgery. After cholecystectomy, a Fogarty catheter, is introduced through the cystic duct. This is followed by a minimal duodenotomy, then incision of the papillar sphincter. In this surgical proposal, we do not intend to substitute technique, but this method should be considered the ultimate solution in the laparoscopic approach to cholecystic choledocholithiasis.     

Systematic review of the surgical treatment for symptomatic os acromiale

The optimal surgical treatment for symptomatic os acromiale that has failed nonoperative management is unclear in the literature. We conducted a systematic review of multiple medical databases for level I-IV evidence. Both radiographic and clinical outcomes were analyzed. Nine studies met the inclusion criteria (118 subjects, 125 shoulders). One hundred and fifteen subjects were treated surgically (122 shoulders). The mean age of the subjects was 49±11 years. The mean preoperative duration of symptoms was 12±8.6 months. Mesoacromiale was the most common type treated (94%). Internal fixation was the most common surgical technique used (60%), followed by excision (27%) and acromioplasty (13%). Rotator cuff repair was the most common concurrent surgical technique (performed in 59% of the surgically treated shoulders), followed by distal clavicle excision (25%). All surgical techniques resulted in improvement in clinical outcomes. Surgical management of symptomatic os acromiale that has failed nonoperative measures may predictably lead to improved outcomes.     

Mandibular fractures in an urban trauma center

The hospital records of 307 patients sustaining mandibular fractures between 1980 and 1984 were reviewed. The patient population consisted of 79% males, with precipitating events usually being fist fights (47%) and assaults with a blunt object (18%). The most common fracture involved the body (30%), followed by the angle (21%) and the condyles (19%). Intermaxillary fixation (IMF) was the preferred method of treatment (42%); however, a large number of patients were treated by internal fixation (31%) or external stabilization (11%). Despite the large number with internal fixation procedures, the complication rate was relatively low (18%). This review suggests changing trends in mandibular fractures. Motor vehicle accidents no longer comprise the most common etiology, so that condylar fractures are no longer the most common, and fractures of the body and angle are more common. Although most patients still are initially treated by intermaxillary fixation, the number of open reductions appears to be increasing. Despite this trend, the complication rate has remained relatively low.     

Hypertension-induced Congestive Heart Failure

Arterial hypertension used to be the most common cause of congestive left ventricular failure. With the availability and common use of antihypertensive treatment the incidence and prevalence of hypertension-induced left ventricular failure has gradually declined. Today congestive heart failure due to underlying coronary heart disease is by far more common than the hypertension-induced variety. The effect of treatment of left ventricular failure in recent years, in particular with angiotensin converting enzyme inhibitors and carvedilol, has been impressive.     

The Incidence of Ischemic Stroke versus Intracerebral Hemorrhage after Carotid Endarterectomy: A Review of 2452 Cases

Carotid endarterectomy is a frequently performed vascular procedure. The most common major perioperative neurologic complication is ischemic stroke. Intracerebral hemorrhage has been traditionally viewed as less common. It has been recently proposed that as technical advances are made, the rate of ischemic stroke and other complications has decreased, causing hemorrhagic stroke to attain increasing importance as a perioperative complication. A review of 2452 consecutive endarterectomies performed by a single surgeon from 1983 to 2000 was performed and rates of ischemic and hemorrhagic strokes were analyzed. There were five hemorrhagic strokes for a rate 0.20% (13.5% of postoperative neurologic complications) and 32 with ischemic strokes for a rate of 1.31% (86.5% of postoperative neurologic complications). From these data we conclude that hemorrhagic stroke remains uncommon and ischemic stroke continues to be the most frequent cause of postoperative neurologic complication after carotid endarterectomy.     

Nonunion of Distal Femoral Fractures: a Systematic Review

Nonunions of the distal femur are inherently difficult to treat and associated with significant patient disability. An extensive search of published reports was conducted and identified articles reviewed to determine the prevalence of various fracture patterns, initial treatment methods, reported risk factors, and definitive treatment methods. The definitive treatment modalities for distal femoral nonunions were then analyzed according to union rate, time to union and complications. The purpose of this review was to determine the risk factors that predispose to nonunion of the distal femur and the most effective treatment methods to implement after nonunion has occurred. The current review assesses 19 studies published over the last 12 years in which there were patients with nonunion of the distal femur and treatment specific to those patients was described. It was found that the most common fracture pattern involved metaphyseal comminution, most common initial treatment was open reduction and internal fixation with plating, most common reported risk factor was an open fracture, and most common definitive treatment was fixed angle plating combined with cancellous autografting. Taken together, the reviewed reports suggest that this form of treatment has a successful union rate of 97.4% and average time to heal of 7.8 months.     

Subacute osteomyelitis

Subacute osteomyelitis is a chronic low-grade infection of bone characterized by a lack of systemic manifestations. The onset is insidious. Pain is the most common symptom, and has usually been present for several months before the initial evaluation. Swelling and tenderness over the area of involved bone may also be seen. Laboratory evaluation is unrevealing, with a normal white blood cell count and differential. The erythrocyte sedimentation rate may also be normal. The most common organism cultured from a subacute osteomyelitis is a staphylococcus species. Twenty-five percent of subacute bone infections are sterile. The most common manifestation of a subacute osteomyelitis in a child is a geographic lytic metaphyseal lesion (Brodie's abscess). Treatment of a culture positive infection includes surgical debridement and antibiotic therapy. A sterile abscess can be treated conservatively without antibiotics, provided the patient's symptoms are improving and the lesion is regressing radiographically.     

Atrial myxoma: 8 years JIPMER experience

Background Myxoma is the most common benign primary tumour of heart. Left atrium is the most common site (75%). With the advent of Trans Esophageal Echocardiography (TEE) the diagnosis has became easier. This study has been under taken to know the clinical profile, surgical techniques and post operative outcome of the patients, operated at JIPMER. Methods Between December 1992 to December 2000, twenty patients of cardiac myxomas were surgically treated. Fourteen (70%) were in the left atrium, three (15%) were in the right atrium one (5%) was biatrial and two (10%) were in multiple chambers. There were 10 males and age ranging from 17 to 65 years. Constitutional symptoms in fifteen, tumour plop in twelve, mid-diastolic murmur in five and syncope in 5 patients were observed. Excision of myxoma was done under cardiopulmonary bypass with bi-atrial approach with a special cannulation technique for the right atrial myxoma. Results Most common site of attachment is fossa ovalis. Tumour size ranged from 4 to 6 cms. There were two early deaths, two patients had conduction disturbances, no recurrence. There was no recurrence in any of the surviving patients. Conclusion Left atrium is the most common site. TEE is the most useful investigation. Biatrial approach preferred for left atrial, biatrial and multiple myxomas. Special technique of going on cardiopulmonary bypass adopted by us is simple and useful for right atrial myxoma. Wide excision of the base prevents recurrence. Multiple myxoma has poor prognosis. (Ind J Thome Cardiovasc Surg, 2001; 17:230-232)     

Implications of 2,457 consecutive surgical infections entering year 2000

OBJECTIVE: To assess the demographics and characteristics of infections in surgical patients to define areas that deserve emphasis in surgical education. SUMMARY BACKGROUND DATA: As a result of evolving technology and diseases, the complexity of diagnosing and treating infections has increased during the past three decades for all patients, including those treated primarily by surgeons. No comprehensive analysis of these conditions in a single surgical cohort has been recently published. METHODS: The authors conducted a prospective, observational study of all infections occurring on the general and trauma surgery services at a single university hospital during a 3.5-year period. RESULTS: The authors identified 2,457 infections: 608 community-acquired, 1,053 occurring on the wards, and 796 occurring in the intensive care unit. Although dependent on patient location, the most common sites were abdomen, lung, and wound; the most common isolates were Staphylococcus epidermidis, Staphylococcus aureus, and Candida albicans; and the most commonly used antibiotics were ciprofloxacin, vancomycin, and metronidazole. The overall death rate was 13%, ranging from 5% after community-acquired infections to 25% after infections acquired in the intensive care unit. CONCLUSIONS: Most infections treated by surgeons are hospital-acquired. Infections with gram-positive cocci and fungi are common, with pulmonary infections becoming more common. Fluoroquinolones have become important therapeutic agents. Depending on the type of practice, these data should be helpful to direct educational efforts so that surgeons can remain knowledgeable and active in the nonsurgical care of their patients.     

Autografts commonly used in anterior cruciate ligament reconstruction

Anterior cruciate ligament reconstruction is among the most common orthopaedic procedures in the United States, with >200,000 performed annually. Much has been published regarding the use of autograft versus allograft. Bone-patellar tendon-bone is the most frequently used autograft, but hamstring and quadriceps tendon grafts are common alternatives. Each graft has distinct advantages and disadvantages, and selection is individualized. Fixation methods vary by graft type. Fixation resulting in a construct that is too rigid may restrict knee range of motion. Donor site morbidity must be considered, as well. Autograft harvest may result in anterior knee pain, kneeling pain, anterior knee numbness, muscle weakness, and patellar fracture. Appropriate graft selection is essential to optimize outcomes.     

Aseptic loosening, not only a question of wear: a review of different theories

Today, aseptic loosening is the most common cause of revision of major arthroplasties. Aseptic loosening accounts for more than two-thirds of hip revisions and almost one-half of knee revisions in Sweden. Several theories on the cause of aseptic loosening have been proposed. Most of these theories, however, are based on empiric observations, experimental animal models or anecdotal cases. In this review, we discuss the most common theories concerning aseptic loosening. It emerges from this review that aseptic loosening has a multifactorial etiology and cannot be explained by a single theory.     

Validation of a novel laparoscopic adjustable gastric band simulator

Background  

Morbid obesity accounts for more than 90,000 deaths per year in the United States. Laparoscopic adjustable gastric banding (LAGB) is the second most common weight loss procedure performed in the US and the most common in Europe and Australia. Simulation in surgical training is a rapidly advancing field that has been adopted by many to prepare surgeons for surgical techniques and procedures. The aim of our study was to determine face, construct, and content validity for a novel virtual reality laparoscopic adjustable gastric band simulator.     

DNA甲基化与肝细胞癌

肝细胞癌是原发性肝癌的主要类型,也是常见的恶性肿瘤之一,具有较高的发病率和病死率。然而在分子和细胞水平,肝癌的发病机制仍然不清楚。一般来说,肿瘤形成通常被认为是抑癌基因失活或原癌基因激活致DNA突变而诱导人类正常细胞向恶性细胞转化的过程。近年来随着对肿瘤研究的不断深入,人们发现表观遗传学改变与肝癌发生发展密切相关。其中DNA甲基化是人类基因组发生最为常见的一种表观遗传学事件,也是表观遗传学研究最为深入的一种机制。本文将就DNA甲基化在肝癌中的研究进展作一综述。     

Pattern of bone injury in Ibadan

A series of 1,329 patients with 1,327 fractures and 100 dislocations has been studied. Boys under 10 years of age predominated. The majority of the injuries resulted from falls or road traffic accidents. Upper limb fractures occurred more commonly than those of the lower limbs or axial skeleton. Femoral shaft fractures were 2-1/2 to 5 times more common while femoral neck fractures were three to five times less common than in Americans. Dislocations were most common at the elbow, followed by the shoulder. Only 11.5% of the patients had open operations; the others were treated conservatively. The prognosis as regards survival and functional results was very good, but malunion was the most common complication.     

Ultrasound-assisted lipoplasty: Is it really safe?

During the last decade liposuction has become the most common aesthetic procedure. It has also become the most common aesthetic procedure performed by physicians not trained in plastic surgery. New developments such as the tumescent technique, finer cannulas, and, finally, the technique of ultrasound-assisted lipoplasty (UAL) have been paralleled by reports of larger amounts of extracted fat. At the same time we see an increasing number of fatal complications. I have undertaken an investigation of 28 patients during 16 months, undergoing liposuction with UAL, to find out how the procedure affected them in terms of blood loss. I found that, while undergoing UAL, our patients lost up to 53% of their blood volume on postoperative day 1, and the average patient still had a loss of 20% of the blood volume 1 week postoperatively.