Superextended facelift: our experience with 3,580 patients

Our experience using the "Superextended" facelifting technique in 3580 female patients is presented herein. The technique is based on extended subcutaneous facial and neck skin undermining, extensive superficial musculoaponeurotic system (SMAS) dissection with low lateral freeing of the edges of the platysma muscle. The trimmed SMAS is fixed to the adjacent tissues, enabling the upward and lateral pulling effect of the facial structures. The neck contour is rebuilt by lateral pulling and fixing of the dissected lateral platysmal edges, along the entire neck, and meticulous supraplatysmal fat sculpturing. The skin is redraped over the newly built SMAS and platysmal skeleton, trimmed, and sutured without any tension. The concept of beauty in the eyes of the surgeon is expressed by adding other ancillary procedures during or shortly after the main procedure. Subcutaneous forehead lift using the hairline incision was performed in 70% of the female patients, concomitantly with the face-lifting procedure. Upper and lower blepharoplasties, chin implant, perioral dermabrasion, rhinoplasty, and fat grafting have been performed according to the surgeon's judgment and the patient's request. The objectives of an ideal facial surgery, which are youthful, natural, dynamic, attractive, feminine, and long-lasting results, can be achieved using this technique. Lack of major complications and an overall minor complications rate of only 4.4% makes this technique safe, reproducible, and reliable. This is one of the largest presented series of this procedure, performed by 1 surgeon. The presented cases demonstrate the results obtained using this technique.     

Aspirin therapy and bleeding during proximal femoral fracture surgery

To assess the effect of daily low-dose aspirin therapy on perioperative bleeding of patients operated on for proximal femoral fracture, we did a prospective case-control study. During 14 months, we followed up 104 patients, 39 of whom were taking aspirin before the injury. The bleeding was estimated by the number of blood units needed perioperatively, the change in hemoglobin values, and followup on complications and drain volume. The aspirin-treated group received an average of 0.5 units of blood more than the control group, postoperatively. This finding was statistically significant. The groups did not differ significantly in any other bleeding parameter. No major bleeding occurred in the patients. It is safe to do surgery for a proximal femoral fracture in patients who are taking aspirin.     

Secondary neurologic deficit due to unrecognized spine instability in multitrauma casualties: a report of three cases

We present three cases of major multiple injuries in which delayed diagnosis of spinal instability resulted in neurologic deficit. The spinal injuries, once diagnosed, were treated by urgent surgical stabilization, which resulted in prompt and full recovery. A set of recommendations is proposed to prevent these potentially disastrous consequences.     

Diagnostic value of galectin-3 as a marker for malignancy in follicular patterned thyroid lesions

BACKGROUND: The determination of malignancy in follicular patterned thyroid lesions is based on postoperative histologic findings. Therefore, affected patients are referred for surgery, although only 20% will have a final diagnosis of malignancy. The aim of this study was to investigate the potential of galectin-3 as a marker of malignancy in these lesions. METHODS: Fifty-four tissue specimens of follicular patterned thyroid lesions were immunohistochemically stained for galectin-3. Area and intensity scores were recorded. RESULTS: Significant differences were found between the benign and malignant lesions. The sensitivity, specificity, positive predictive values, and negative predictive values of galectin-3 staining were 82%, 68%, 75%, and 77%, respectively (p=.0002). Significant differences were also found between the subgroups of benign and malignant lesions (p < or =.05). CONCLUSIONS: Galectin-3 staining is highly sensitive for malignancy in follicular patterned thyroid lesions. Diagnostic problems may arise in the presence of Hurthle cell proliferation or minimally invasive follicular carcinoma.     

Physicians' attitude toward identification and management of childhood obesity in Israel

Obesity is a serious health problem, and is becoming increasingly common in affluent societies. In 1998, an Expert Committee published guidelines regarding obesity evaluation and treatment. The purpose of this study was to assess the attitude of primary care physicians in Israel toward diagnosis and treatment of childhood obesity, as related to the recommended guidelines. Primary physicians caring for children and adolescents were asked to complete an anonymous questionnaire including personal and professional details, methods of diagnosis, documentation and treatment of childhood obesity, and familiarity with and implementation of the Expert Committee recommendations. One hundred forty-four physicians, treating approximately 100,000 children monthly, completed the questionnaire. Ninety-four percent were considered to have diagnosed obesity properly. Furthermore, only 19% reported weighing all children examined, while 99% of the physicians suggested some treatment for obesity. The most frequent recommendations for managing obesity were referral to a dietitian (92%), physical exercise (85%), and group treatment (27%). The majority of physicians (78%) were not familiar with the new Expert Committee recommendations regarding obesity treatment. This study suggests that the majority of primary physicians diagnose obesity properly and recommend accepted modalities to manage obesity. A comprehensive program to prevent and treat obesity is recommended to improve the health status of the population.     

Clinical presentation and anatomic position of L3-L4 disc herniation: a prospective and comparative study

OBJECTIVE: A prospective, controlled cohort study was conducted to assess the anatomic transverse location and clinical presentation of L3-L4 disc herniation compared with lower lumbar levels. METHODS: This study prospectively identified 37 patients diagnosed with L3-L4 disc herniation (study group) and 52 patients diagnosed with L4-L5 and L5-S1 herniation (control group). The following clinical data were collected: age, femoral stretch test, motor strength, sensation, and deep tendon reflexes. The anatomic transverse location of the disc fragments was assessed by computed tomography or magnetic resonance imaging and was classified as either central, posterolateral, foraminal, or far lateral. RESULTS: The patients in the study group were older than the patients in the control group, and neurologic deficit was more common. The transverse location was foraminal and extraforaminal in 59% of the study group compared with 27% of the control group. These differences were statistically significant. CONCLUSIONS: The incidence of foraminal and far lateral disc herniation is significantly higher at the L3-L4 level compared with lower lumbar levels. When examining an older patient complaining of thigh pain, special attention should be given to the quadriceps strength, patellar reflex, and femoral stretch test. The L3-L4 foraminal and extraforaminal area should be assessed carefully.     

Outcome of consecutive trabeculectomy

Purpose: To establish a criterion for success of primary phakic trabeculectomy in the second eye of the same patient, using the first operated eye as a predictor for the surgical outcome. Methods: The outcome of primary phakic trabeculectomy was retrospectively compared in both eyes of 23 patients. Sixteen patients were treated with antimetabolites and seven were not. Postoperative intraocular pressure and number of glaucoma medications in paired eyes of the same patients were compared. Surgical success was defined as postoperative IOP of <20 mmHg without medication. Bleb morphology and the number of glaucoma medications were also compared in both eyes. Results: There was a positive correlation between the two eyes of a patient in the IOP values at each postoperative time point in both groups (with and without antimeta­bolites) (P > 0.05). At the last follow‐up visit after trabeculectomy, the number of glaucoma medications used in paired eyes were not significantly different (P > 0.83). Surgical failure occurred more often in paired eyes than in single eyes. Bilateral failure occurred in 60% (3/5) of the failed trabeculectomies with antimetabolites and in 100% (3/3) of the failed trabeculectomies without antimetabolites. Conclusion: Trabeculectomy outcome in paired eyes of patients was similar in both antimetabolites treated and untreated eyes. Thus, trabeculectomy outcome in the first operated eye can predict the surgical result in the second eye of the same patient.