The deposition. The defendant's perspective

A positive, well-prepared deposition may be the best defense in a medical malpractice suit that ultimately may change the course of a physician's career. In this article, the author explains the purpose, format, and overall significance of the deposition and offers advice on how best to handle it. The author enumerates the steps that the defendant should take before, during, and after the deposition.     

带神经的邻指皮瓣修复示中环指指腹缺损

目的 介绍一种修复示、中、环指指腹缺损的方法。方法 运用带有尺侧指固有神经背侧支的邻指皮瓣,修复示、中、环指指腹缺损,并将所带神经吻合于桡侧指固有神经残端。术后待皮瓣断蒂后测量并随访其疗效。结果 皮瓣全部成活,外观良好,患者自觉满意。随访并测量两点辨别觉桡侧达5～7mm,尺侧达8～10mm。结论 对于示、中、环指指腹缺损,修复其创面,恢复其感觉功能,尤其是桡侧的皮肤感觉功能比较重要。此方法操作简单、成活率高,值得推广。     

The Classic: The Cervical Syndrome

This Classic article is a reprint of the original work by Ruth Jackson, MD, FACS, The Cervical Syndrome. An accompanying biographical sketch on Ruth Jackson, MD, FACS, is available at DOI 10.1007/s11999-010-1277-9. The Classic Article is ©1949 by The Dallas County Medical Society and is reprinted with permission from Jackson R. The cervical syndrome. Dallas Med J. 1949;35:139–146. A second Classic Article, The Cervical Syndrome, is attached to this article as Electronic Supplementary Material (supplemental materials are available with the online version of CORR). This article is ©1955 by Lippincott Williams and Wilkins and is reprinted with permission from Jackson R. The cervical syndrome. Clin Orthop Relat Res. 1955;5:138–148.     

面神经腮腺外分支的解剖学研究及其临床意义

目的 准确地描述面神经腮腺外段的分支,走行等情况,为颌面外科、头颈部整形与美容外科提供重要的形态学资料.方法 20具(40侧)新鲜成人头颈部标本,在手术显微镜下解剖观察并记录照相;利用上述形态学资料作为各种面神经损伤的诊断依据,指导相关手术的设计、分离和寻找面神经分支.结果 ①五组神经的分支数个体差异很大,平均颞支3.2支,颧支2.2支,颊支3.6支,下颌缘支1.3支,颈支恒为1支.②面神经急诊损伤探查缝合术12例,均成功.二级吻合前的损伤才具有神经缝合的条件,而二级(集中)吻合后的分支极其细小,探查、缝合基本不可能.③做面神经解剖术或者其他手术需辨清面神经各支时,颞中筋膜和咬肌筋膜是重要的标志.腮腺混合瘤切除面神经解剖术4例,跨面神经移植术2例,SMAS-颈阔肌除皱术千余例.这些手术中,发生明确的医源性面神经颧支损伤2例.结论 ①除颈支或单支的下颌缘支外,各组神经支可以被损伤或切断1～2支而不至于造成严重、永久的瘫痪;②在手术中,颞中筋膜与咬肌筋膜既是重要的保护结构,又是明确的辨别寻找标志.     

The Johns Hopkins: The blalock-taussig era

Indian Journal of Thoracic and Cardiovascular Surgery -     

The Classic: The Bulkley Lecture: The Modern Attitude Toward Traumatic Cancer

This Classic Article is a reprint of the original work by J. Ewing, The Bulkley Lecture: The Modern Attitude Toward Traumatic Cancer. An accompanying biographical sketch of J. Ewing is available at DOI  10.1007/s11999-011-2234-y. The Classic Article is ©1935 and is reprinted courtesy of the New York Academy of Medicine from Ewing J. The Bulkley Lecture: The Modern Attitude Toward Traumatic Cancer*. Bull N Y Acad Med. 1935;11:281–333.     

The jumbo cup: The 95% solution

Revision total hip arthroplasty can present many challenges to the surgeon, this is particularly true on the acetabular side. Acetabular deficiencies are frequently encountered that traditionally required complex reconstruction techniques. The introduction of improved metals and jumbo cup options has revolutionized the management of these deficiencies into a flexible, reproducible, and less technically complex procedure for a revision arthroplasty surgeon to perform. The literature is sparse, but the evidence points to very good results with uncemented acetabular cups in revision total hip arthroplasty. The technique for implantation of jumbo cups will be outlined as well.     

The Classic: The Operative Treatment of Fractures

This Classic article is a reprint of the original work by William Arbuthnot Lane, The Operative Treatment of Fractures. An accompanying biographical sketch on William Arbuthnot Lane, M.S., F.R.C.S., is available at DOI  10.1007/s11999-009-0861-3. The Classic Article is ©1909 by Wolters Kluwer Health-Lippincott Williams &; Wilkins and is reprinted with permission from Lane WA. The operative treatment of fractures. Ann Surg. 1909;50:1106.     

The need for lung transplantation in The Netherlands

The aim of this study was to assess the future need for lung transplantation in the Netherlands in the absence of limiting factors, such as a shortage of donor organs. The need was estimated using two different methods. In method 1, estimation of the need was based on data from the Dutch lung transplantation program, collected during a 4-year period (1 April 1992 until 31 March 1996). In method 2, the need was estimated using national mortality data over a 5-year period (1987–1991) preceding the start of the Dutch lung transplantation program. The results of both methods were corrected for known factors of distortion. The number of lung transplantations needed in the Netherlands in the future was estimated to range from 50 to 80 a year, which corresponds to 3.2–5.2 transplantations per million inhabitants per year. Considering the current supply of donor lungs in the Netherlands, only about one-third of the patients in need of a lung transplant in the future will be able to receive one. Received: 5 March 1997 Received after revision: 22 May 1997 Accepted: 9 July 1997     

The classic. The biology of functional restoration

In 1902, when Americans were traveling to Austria and Germany for postgraduate training, Arthur Steindler (1878-1959) emigrated from his native Austria to the middlewestern United States to complete his education. After graduating from the renowned University of Austria in 1902 and completing postgraduate orthopedic training under Lorenz in 1907, he continued clinical work in Chicago under Ridlon until 1910. Ridlon recognized his scholarly qualities and recommended him for a professorship, first at Drake University and then at the University of Iowa, where from 1913 to 1949 he organized the most advanced statewide crippled children's service in the country. Steindler pioneered the application of biomechanics to orthopedic problems and wrote the first comprehensive book on the mechanics of locomotion. He educated more than 300 resident orthopedic surgeons from all parts of the world. He may have been the first to write long-term end-result statistics for each operation in a textbook on orthopedic surgery.     

The Arrhinias

The Arrhinias consist of three groups of malformations: the Total Arrhinias (T-AR), the Hemi-Arrhinias (H-AR, often called Hemi-Nasal Ageneses) and the Proboscis Lateralis (P.L.) This work deals with 51 cases of Arrhinias gathered within 35 years (8 T-AR, 25 H-AR, and 18 P.L): their anatomy, clinical signs, and some indications for treatment; but it does not extend to a discussion for their etiopathology. However, the T-AR and the H-AR represent ageneses, whereas the P.L represents a dysgenesis. The anomalies common to the three groups of Arrhinias are many: the agenesis of the nasal bones, the telecanthus which is often in contrast to the hypo-telorbitism, the obstruction of the naso-lacrimal passage, the ectasia of the lacrimal sac with an erosion of the inferomedial angle of the orbit, the hypopneumatization of the maxillary sinus and a small maxilla, the unerrupted canines, the flattened fronto-nasal process, the obliteration of the cribriform plate, the dysplasia in the root of the eyebrows, the transverse hypoplasia of the upper lip, the frequency of microphthalmia, colobomas of the iris and nystagmus. Cleft lip and palate are frequently associated with the Arrhinias (see Table I) and also other facial malformations, but in different proportions, according to groups. They are: cryptophtalmias, eyelid coloboma, fronto-orbital encephalocele, agenesis of the premaxilla or prolabium, microtia. (See Table II) The basic principles of the treatment are the following: In the T-AR, a nasal passage should initially be bored through the maxilla, or there should be a displacement of the two halves of the mid-face by a procedure known as “facial bipartition”. This nasal passage should be epithelialized and maintained wide open to the pharynx until the nasal construction. In the H-AR, it is sufficient to create an epithelialized passage through the curtain of bone where one would expect the pyriform rim to be and carry this passage through the septum into the contralateral nasal airway. Then, regardless of the type of arrhinia, the nasal construction is carried out with a forehead flap and bone grafts. The first grafts are either iliac or tibial, and subsequent ones are generally outer table calvarial grafts harvested from the parietal region. Later, there are further procedures: a maxillary advancement, a lengthening of the central midface, the final stages of the nasal construction, the elevation of the medial canthus, and the restoration of the infero-medial angle of the orbit (but rarely an efficient lacrimal drainage). The earliest stage for surgery can be debated. A strategy for treatment is suggested. Finally, 20 brief comments are made, which are as much questions asked concerning the three groups of arrhinia and their relationship with other centro-facial and latero-facial malformations.     

The pancreas

The pancreas plays a vital role in coordinating and regulating digestion and nutrient metabolism, and does so via endocrine and exocrine processes. Insulin and glucagon are produced within the endocrine pancreas to not only achieve glucose homeostasis, but regulate protein and fat metabolism. Enzymes and zymogens are secreted in alkaline pancreatic fluid to aid digestive function. This article looks at how the pancreas achieves such precise synthetic and secretory functions, and reviews the physiology of the secreted hormones and enzymes.     

The pancreas

Although only the same weight as an apple, the pancreas fulfils endocrine and exocrine functions, and coordinates metabolism throughout the body. For example, insulin, perhaps the best-known pancreatic hormone, not only influences glucose metabolism but also helps to regulate protein and fat metabolism (thus explaining why diabetes is more than just a disease of sugar). The secretion of pancreatic hormones is highly coordinated to exert a concerted effect on the metabolism of a range of organs, from adipose tissue to muscle. This article looks at the physiology of each of the hormones and enzymes released by the pancreas, the factors influencing their secretion, and how their secretion is coordinated.