Clubfoot: Etiology and treatment

Congenital talipes equinovarus is the commonest congenital anomaly with an incidence of one to two per 1000 live births. Over the centuries it has been treated by various modalities, but the dilemma facing the surgeon has been a strong tendency to relapse. With the use of the Ponseti technique, the number of patients who undergo soft tissue release has decreased. This technique probably represents a panacea for the treatment of this unsolved mystery.     

Operative Techniques in the Fetal Rabbit

The development of fetal surgical techniques has made the antenatal correction of congenital defects possible. These techniques have evolved from trials with animal models, permitting increasingly sophisticated operations with low morbidity and mortality. Experimental models range from large animals offering longer gestations but with single pregnancies and high cost, to smaller animals offering multiple pregnancies at reduced cost but with shorter gestations. This paper describes operative techniques in the fetal rabbit and its advantages as a fetal surgical model. Experience with the pregnant rabbit has shown it to be a suitable surgical model for several reasons. Pregnancies are multiple, increasing cost effectiveness and permitting operation on up to eight fetuses per litter without fetal loss. Techniques that promote fetal survival include local housing of does several days prior to operation and preoperative sedation. Spontaneous mask ventilation provides ease of anesthetic administration and titration. Overall surgery is well tolerated with a low incidence of intraoperative complications. Rabbit models have been used in the study of transamniotic fetal feeding, abdominal wall defects, and wound healing. These techniques have resulted in postoperative fetal viability approaching 90%, with negligible maternal mortality in over 4000 fetal operations, thereby making the rabbit a manageable cost-effective model of fetal surgery.     

Coronary transfer in the arterial switch operation: the modified closed technique

Arterial switch operation for transposition of great arteries (TGA) is the choice of surgical treatment for this condition. Conventional “open” coronary transfer technique has been commonly employed with good results in experienced hands. A modified “closed” technique of coronary transfer, with a more accurate coronary artery placement taking into account a distended aorta, along with anterior interrupted sutures to reduce purse stringing and other advantages is described.     

内窥镜骨膜下额颞部除皱术

为了减少面部、额颞部除皱术的手术创伤和手术并发症,提高手术疗效。应用内窥镜骨膜下切断皱眉肌,降眉肌和鼻根部锥形肌同时悬吊枕额肌的面部除皱术。1995年1～11月在斯德拉斯堡欧洲美容整形诊所共行手术37例,分别于术后8天,3个月和6个月随访,外观效果满意。认为内窥镜骨膜下除皱术,通过额眉部肌肉的分离切断和悬吊可以取得良好的效果,易为求术者所接受。     

Implantation Technique for the HeartMateR Left Ventricular Assist Device

The technique for implanting the HeartMate, an intraabdominally placed, pulsatile left ventricular assist device, is described. This device, which has been developed for potential use in patients requiring permanent left ventricular assistance, is currently undergoing clinical investigation in patients requiring temporary support as they await cardiac transplantation. This clinical experience has demonstrated device safety and efficacy, even for patients requiring extended periods of support.     

Modified Scharli technique for the very long gap esophageal atresia

This modification of the Scharli technique which creates an isoperistaltic tube to overcome very long gap esophageal atresia involves retention of the short distal esophageal segment and creation of a neo-esophagus of tubularized gastric fundus of even calibre, similar to that of the upper esophageal segment. It has proved simple and effective in establishing esophageal continuity.     

机器人辅助腹腔镜胰十二指肠切除术

胰十二指肠切除术(pancreaticoduodenectomy,PD)被认为是普通外科手术中较难和复杂的手术,即使对于有经验的外科医生也是如此.     

Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft two-incision technique

Anterior cruciate ligament (ACL) reconstruction can be performed with a variety of techniques. Multiple graft sources for reconstruction are also available. The senior author (JRS) has used an arthroscopically assisted technique with 2 incisions that has achieved consistently good results. One incision is made over the patellar tendon, allowing harvest of the bone-patellar tendon-bone graft and tibial tunnel placement and graft fixation. A second lateral incision is used for femoral tunnel placement and fixation. This method has produced predictably good results and avoids some of the potential complications of endoscopic ACL reconstruction.     

Digital subtraction angiography (DSA): New perspectives in angiography

Summary Digital subtraction angiography (DSA) has strongly influenced angiographic procedures. Because it is less invasive it has increased the total number of angiographies in all places where it was introduced. The paper gives an introduction to the procedure explaining the roles of digital and subtraction in DSA. It is written from a technical point of view. The examples are taken from and with the DVI system.     

髌骨骨折生物力学研究及治疗方法的评价

本文分析了髌骨及髌骨骨折采用改良强力带钢丝固定法的生物力学。对采用改良张力带钢丝固定治疗髌骨骨折６４例进行观察。根据生物力学的原理和临床观察结果显示，此术式具有骨折愈合快，关节功能恢复好等明显优越于其它诸多方法之特点。同时还介绍了用２枚空心螺丝钉加钢丝固定治疗髌骨横形骨折的新方法。     

生物发光技术定量检测SD鼠睾丸组织内端粒酶活性的实验研究

目的：定量研究不同月龄SD(Sprague—Dawley)鼠睾丸组织内端粒酶活性的表达及其意义。方法：应用生物发光技术原位杂交技术，对各月龄组健康雄性SD鼠睾丸组织中端粒酶活性进行了定量检测，并结合光镜、电镜观察对不同月龄SD鼠睾丸组织内的端粒酶活性表达状况进行了研究。结果：从出生后第l天直到第27个月，各月龄组雄性SD鼠的睾丸组织中均可检测到端粒酶活性的表达(阳性率l00％)。出生后第9天时SD鼠睾丸中可检测到高水平的端粒酶活性。结论：SD鼠睾丸组织中终生表达端粒酶活性，作为雄性生殖系统的干细胞，A型精原细胞表达高水平的端粒酶活性。     

皮质外骨桥技术结合骨皮质切削技术治疗股骨骨不连29例疗效分析

[目的]探讨运用皮质外骨桥技术结合骨皮质切削技术治疗骨不连的临床效果.[方法]对2004～2010年本科收治的29例股骨骨不连患者进行回顾性对照研究.其中运用皮质外骨桥技术结合骨皮质切削技术治疗的患者16例作为实验组,其余13例运用传统自体骨植骨内固定方法治疗作为对照组.实验组中11例运用皮质外骨桥技术,5例运用皮质外骨桥技术结合骨皮质切削技术治疗.随访期限为13个月～2年,所有患者均在术后第1d及术后每月行X线检查至骨折临床愈合,收集2组资料,比较骨折影像学愈合时间以及下地完全负重时间,运用SPSS17.0统计软件包对2组数据进行统计检验.[结果]2组患者骨不连均在5～9个月达到临床愈合,疗效良好.实验组与对照组相比,骨折影像学愈合时间以及下地完全负重时间明显缩短,有显著统计学差异.[结论]运用皮质外骨桥技术结合骨皮质切削技术治疗股骨骨不连与传统手术方法相比,骨折影像学愈合时间以及完全负重时间明显缩短,具有良好的临床效果,有一定的临床推广价值.     

Laparoscopic operative technique for adrenal tumors.

BACKGROUND AND OBJECTIVES: Laparoscopy has acquired an unquestionable position in surgical practice as a diagnostic and operative tool. Recently, the laparoscopic approach has become a valuable option for adrenalectomy. This paper reports, in detail, our experience of laparoscopic adrenalectomy performed for adrenal tumors. METHODS: We performed 12 laparoscopic adrenalectomies from October 29, 1997 to October 31, 1998. The technique of laparoscopic adrenalectomy is described thoroughly in all relevant details for either left or right-sided adrenal lesions. RESULTS: The presented technique of laparoscopic adrenalectomy in all 12 cases provided good and relatively simple exposure of the immediate operative area. All relevant vascular elements were safely controlled, adrenal tumors could be successfully removed, and adequate hemostasis was achieved. No intraoperative or postoperative complications were observed. CONCLUSIONS: Laparoscopic adrenalectomy is a safe alternative to open surgery and is preferred for most patients because of shorter postoperative hospital stay and less postoperative discomfort.     

EN BLOC RADICAL CYSTOPROSTATOURETHRECTOMY WITH PRESERVATION OF SEXUAL FUNCTION

Background:
Recent understanding of the precise anatomy of the cavernous nerves to the penis allows us to preserve potency in men undergoing radical prostatectomy or radical cysto-prostatectomy. A technique of urethrectomy that preserves potency has been also developed. To date, however, delayed urethrectomy has been recommended to preserve potency. We have applied a nerve-sparing technique to en bloc cystoprostatourethrectomy.
Methods:
Seven patients have undergone simultaneous urethrectomy with the radical cystoprostatectomy by the nerve-sparing technique. Patient age ranged from 52 to 69 years (mean age, 61.3 years). All patients were potent preoperatively. Meticulous and complete dissection of the membranous urethra from the pelvis is the key to preservation of potency at urethrectomy.
Results:
The patients were followed for 7 to 64 months (mean, 27.3 months). Four (57%) of the patients regained potency postoperatively. Two patients were able to have erections postoperatively but are still impotent.
Conclusions:
Our clinical results show that it is possible to perform simultaneous urethrectomy and preserve potency.     

同种原位背驮式减体肝移植技术

继中国首例背驮式同种原位肝移植在同济医院施行成功近１年后,作者又于１９６年采用背驮式减体积同种原位肝移植技术为１例９岁,体重仅２０．５ｋｇ的男性Ｗｉｓｏｎ氏患儿成功施行了手术,该手术与经典的同种原位肝移植（ＳＯＬＴ）相比下半躯体静脉回流影响小,内环境干扰小,有利于患者术后恢复,此例ＰＢＲＳＯＬＴ施行成功,填补了中国儿童肝移植手术技术的空白,为儿童各种良性终末期肝脏疾病开创了新的外科治疗手段,兹就手     

Induced Membrane Technique for the Management of Segmental Femoral Defects: A Systematic Review and Meta-Analysis of Individual Participant Data

Several modifications of the induced membrane technique (IMT) have been reported, but there is no consensus regarding their results and prognosis. Moreover, most studies have focused on tibial defects; no meta-analysis of the treatment of femoral defects using the IMT has been reported. This systematic review and meta-analysis aimed to identify the potential risk factors of post-procedural complications following the treatment of segmental femoral defects using the IMT. A comprehensive search was performed on the Cochrane Library, EBSCO, EMBASE, Ovid, PubMed, Scopus, and Web of Science databases, using the keywords “femur,” “Masquelet technique,” and “induced membrane technique.” Original articles composed in English, having accessible individual patient data, and reporting more than two cases of bony defect or nonunion of femur or more than five cases of any body part were included. Post-procedural bone graft infections, final union status, and union time after second-stage operation were analyzed. Fourteen reports, including 90 patients, were used in this study. External fixation in second-stage surgery had an odds ratio of 9.267 for post-procedural bone graft infection (p = 0.047). The odds ratio of post-procedural bone graft infection and age >65 years for final non-union status was 51.05 (p = 0.003) and 9.18 (p = 0.042). Shorter union time was related to impregnated antibiotics in the spacer (p = 0.005), transplanting all-autologous grafts (p = 0.042), and the application of intramedullary nails as the second-stage fixation method (p = 0.050). The IMT appears to be reasonable and reproducible for femoral segmental bone defects. Several preoperative and surgical factors may affect post-procedural complications and union time.     

Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique

The robotic technique, which was first introduced in laparoscopic heart surgery, has revolutionized laparoscopic surgery over the last 5 years. In May 2000, our department accomplished the first robot assisted laparoscopic radical prostatectomy. Since that time we have performed more than 118 such procedures and several other laparoscopic operations using the robotic technique. We here summarize our experience in robot assisted laparoscopic radical prostatectomy as it has been developed over the past 3 years. Between May 2000 and May 2003, 118 patients with clinically localized prostate cancer were operated using the telerobotic da Vinci Surgical System. Operations were performed with a senior surgeon at the console, assisted by an assistant and a nurse at the operating table. Bilateral pelvic lymph node dissection was undertaken as a first step in all patients. In the initial 60 cases, we investigated different laparoscopic approaches. We used transperitoneal as well as extraperitoneal approaches. For dissection of the prostate we used ascending, descending as well as combined techniques. The combined ascending and descending technique via the transperitoneal route was chosen in 30 patients, and via the extraperitoneal route in seven patients. A modification of the descending Montsouris technique was performed in 81 patients. The robot assisted laparoscopic radical prostatectomy with the da Vinci system has been well standardized. After performing more than 100 radical prostatectomies with this system, we conclude that in our hands the Mountsouris technique with only minor adoptions is the most appropriate technique for performing robot assisted radical prostatectomy.     

The modified hexagonal technique for reduction mammoplasty and mastopexy

In 1982, we described the hexagonal technique for correction of breast ptosis or moderate degree of breast hypertrophy. Since then we have modified the technique mainly to be able to correct the severe as well as the moderate degree of breast hypertrophy. This technique has provided the versatility in achieving good results in various degrees of reduction mammoplasty and mastopexy.Presented in part to the Egyptian Society of Plastic and Reconstructive Surgeons in Cairo, Egypt, March, 1984     

Does reflux in orthotopic diversion matter? A randomized prospective comparison of the Studer and T-pouch ileal neobladders

Purpose  Orthotopic neobladder reconstruction has become a standard form of urinary diversion in many centers for patients undergoing radical cystectomy for bladder cancer. There is still controversy about the best technique for construction of the neobladder, and especially whether it is necessary to include an antireflux mechanism. Methods  We designed a prospective randomized clinical trial comparing two forms of ileal neobladder: the Studer pouch and the T-pouch. The latter includes an extraserosal tunneled afferent limb which prevents reflux from the pouch to the kidneys. The primary endpoint of the study is renal function and anatomy at 3 years following surgery, with secondary endpoints including early and late postoperative complications, renal infections and need for secondary procedures. Results  To date we have randomized 462 patients over approximately 6 years, with a planned full enrollment of 550 patients. Ten percent of patients have been withdrawn because they did not undergo the planned orthotopic diversion due to a positive urethral margin on frozen section. We expect approximately 70% of patients to be alive and available for follow-up at 3 years, which will give us ample power to detect clinically meaningful differences in the outcome of these two diversions. Conclusion  This trial has been feasible and randomization has been acceptable to most patients. Long-term follow-up of the patients on this trial should be able to definitively answer the question of the importance of an antireflux mechanism in the orthotopic neobladders construction.     

肝离断技术的进展与应用

肝部分切除术作为治疗肝良恶性疾病的主要手段，使大量的肝病患者受益，其中肝离断技术作为肝切除术的基础，随着外科技术和医疗设备的发展，得到了实质性的进步，由最初的能切除病变肝脏，到今天不仅切除病灶，还要做到损伤小、出血少、恢复快，进一步提高手术的安全性，降低患术后并发症发病率。除此之外，肝离断技术应用过程中，还需考虑个体差异、医院条件、术者经验等重要因素的影响。