Early experience with Lejour vertical scar reduction mammaplasty technique

The study contains 163 patients who underwent a reduction mammaplasty at the Karolinska Hospital during 1991–1992. Seventy patients were operated on using the Lejour short scar technique (superovertical pedicle) and 93 using the Strömbeck method (medial pedicle). The aim of this study was to compare the results of these two different methods with regard to scar formation, position and sensation in the nipple areola complex, postoperative complications, healing conditions, shape and volume symmetry of the breasts and patient satisfaction. An objective method [20] was used for assessment of postoperative breast asymmetry. Advantages and disadvantages of both methods are presented. The incidence of early complications was low in both groups, compared with the data presented in the literature, but Strömbeck's method was found to be superior in some respects because of fewer early postoperative complications, shorter healing period and better breast symmetry postoperatively.     

Life satisfaction after reconstruction of complexe lower limb injuries

Summary 58 patients following Gustilo IIIB open tibial fractures, treated by serial debridements, osteosynthesis and microvascular free tissue transfer were investigated after an average of 6 years. Assessment of life satisfaction was done by means of a proven valid and reliable test instrument (FLZ –“Fragen zur Lebenszufriedenheit”). Further specific questions on treatment satisfaction, aesthetic result, occupation and income were added to this questionnaire. Significant discrepancies of the items recreational activities, income, occupation and partnership, productivity, mobility and pain were evaluated in comparison to available data of healthy west german population. The calculated global index of life satisfaction and health differed significantly from the established index of west german population. Although specific aspects like aesthetic result, donor site morbidity, pain and even function were critically judged, 91 % of the patients were satisfied with the long term result of the treatment. None of the patients thought that an initial amputation probably might have been a better solution. The postrehabilitation employment rate was 64 %. Limb salvage of Gustilo IIIB fractures by means of a multidisciplinary treatment protocol is able to afford useful and satisfying long time results. However, an impairment of quality of life, at least in specific items has to be considered.      

An objective method for the measurement of skin sensibility

Summary The importance of the return of sensibility in transplanted skin as a functional necessity for the success of a surgical reconstruction, especially in the hand, has led to many studies to develop a technique for the evaluation of postoperative sensibility, in which the application of the sensory stimulus is constant, controlled, and the degree of sensibility recorded without the subjective collaboration of the patient. Since the tactile and pain stimuli are appreciated by nerve fibres which are different from those which register thermal sensation, two different apparatuses have been devised to evaluate these two aspects of sensibility. Experimental studies and clinical application of these two methods are reported.     

Long-term Results Wearing Hard Contact Lenses in Monocular Aphakia

It is a fairly common misconception that monocular aphakes have not performed well with hard contact lenses over the long term. To investigate this the records of 148 monocular aphakes who were fitted successfully to hard contact lenses between 1968–1973 were reviewed. Ninety-four percent of this group were still wearing their lenses an average of 5.1 years later, while 6% had stopped. Both groups were studied for age, sex distribution, duration of lens wear, and reasons for stopping.     

Die Bedeutung der Punktionscytologie bei Brustdrüsenerkrankungen

Zusammenfassung Berichtet wird über das Verfahren der Punktionscytologie, welches im Zeitraum von 1967 bis 1978 bei 612 Patienten durchgeführt wurde. Aufgrund eigener Erfahrungen wird die Wertigkeit der Cytodiagnostik im Rahmen der Tripel-Diagnostik hoch eingeschätzt. Ihre Treffsicherheit erreicht 98–100%, gegenüber der Trefferquote von 60–88% der klinischen bzw. mammographischen Untersuchung. Die Punktionscytologie wird als zuverlässiges und ambulant durchführbares diagnostisches Kriterium für die tägliche Praxis empfohlen.

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Aspiration biopsy cytology of the diseases of the mammary gland

Summary A detailed report is given on the results of aspiration cytology used in 612 patients. On the basis of his own experiences he speaks high of cytodiagnostics in the complex of cyto-radio-clinical triplet, where its value may reach 98–100% to the contrary of 60–88% of the other two components. It is rapid, trustful, undangerous, in everyday practice is suggested at every place, where the personal and objective conditions are guaranteed.

     

Therapy and prognosis of testicular carcinomas in relation to tnm classification

Eight-hundred and thirty-one patients with testicular carcinomas, either teratocarcinoma (405), embryonal carcinoma (406) or pure choriocarcinoma (20), treated mainly at our center from 1950 to 1976, were clinicopathologically staged according to the TNM Classification. The cancer was confined to the body of testis alone (T₁ N₀ M₀) or extended to paratesticular structures (T_2–4 N₀ M₀) in 37% of all patients. Para-aortic lymph nodes were found involved (N_1–3)in 33% and juxtaregional lymph nodes (N₄) in 9% of patients; distant metastases were detected initially in the lung alone (M₁) and other distant organs (M₂) in 21 % of the patients. Postorchiectomy treatment was retroperitoneal lymphadenectomy with or without regional-juxtaregional irradiation and systemic chemotherapy in 470 patients; the other 361 patients received external irradiation and/or adjuvant chemotherapy. Survival determined at 5 years was 58 % in teratocarcinoma cases, 41 % in embryonal carcinoma cases and 0 % in pure choriocarcinoma cases. Rates of 5-year survival according to the TNM staging were 81 % for T₁ N₀ M₀ tumors, 58 % for T_2–4 N₀ M₀ tumors, 44% for N_1–3 M₀ tumors, 33% for N₄ M₀ tumors and 10% for N_0?4 M_{1 or 2} tumors. In patients who underwent lymphadenectomy with or without external irradiation, the 5-year survival rates with and without adjuvant chemotherapy, respectively, were 96% and 86% for T₁ N₀ M₀ tumors, 100% and 60% for T_2–4 N₀ M₀ tumors, 66% and 42% for N_1–3 M₀ tumors, 54% and 40% for N₄ M₀ tumors and 38% and 0 % for N_0?4 M₁ tumors. In patients treated by external irradiation alone or following lymphadenectomy the rates of 5-year survival with versus without adjuvant chemotherapy were 100% versus 66% for T_1–4 N₀ M₀ tumors, 44% versus 18% for N_1–3 M₀ tumors, 41 % versus 22 % for N₄ M₀ tumors and 3 % versus 4 % for N_0–4 M_1–2 tumors.     

Bilateral Hand Transplantation: Six Years After the First Case

In this study we present our experience concerning bilateral hand transplantation. Two cases were performed: the first in January 2000 and the second in April 2003. Both recipients received the same immunosuppressive treatment, which was similar to those used in solid organ transplantation, including tacrolimus, prednisone and mycophenolate mofetil while antithymocyte globulins were added for induction. Both recipients presented two episodes of acute rejection (maculopapular lesions) in the first 3 months after transplantation; however, these were easily reversed after a few days increasing oral steroid doses and using topical immunosuppressants. The first recipient presented hyperglycemia and serum sickness while the second recipient suffered a thrombosis of the right ulnar artery and an osteomyelitis of left ulna. All the complications were successfully treated. Functional Magnetic Resonance Imaging (fMRI) showed that cortical hand representation progressively shifted from the lateral to the medial region in the motor cortex. After 6 and 2 years respectively, they showed a relevant sensorimotor recovery particularly of sensibility and activity of intrinsic muscles. They were able to perform the majority of daily activities and to lead a normal social life. The first recipient has been working since 2003. They are both satisfied with their grafted hands.     

The ileo neo rectal anastomosis (INRA) in patients with familial adenomatous polyposis: clinical results at two years

BACKGROUND: Ileo neo rectal anastomosis (INRA) is a promising alternative for patients with familial adenomatous polyposis (FAP) to restorative proctocolectomy with its morbidity and unpredictable functional outcome to colectomy with ileo rectal anastomosis (IRA) with the continuing risk of rectal cancer. The aims of the present study were to evaluate the function of the neorectum, to assess the morbidity and complications of the operation and to determine the incidence of neorectal polyps. METHODS: Data of all patients having INRA, including bowel function and complications, were prospectively recorded. The reservoir capacity was determined repeatedly by physiologic tests. The anal sphincter complex was assessed by manometry and ultrasound examination. Evaluation of the neorectal mucosa was performed by endoscopy. RESULTS: Six patients underwent the INRA procedure for FAP. Median defaecation frequency two years postoperatively was 5.5/24 h (range 4-7) including 1/night (range 0-2). Endoscopic examination showed normal mucosa and no evidence of polyp formation in all patients. CONCLUSION: INRA affords a good functional reservoir and is accompanied by few reservoir-related complications. At a minimum follow up period of two years, no growth of polyps in the neorectum occurred.     

Enhancing cancer trial management: An intervention study of the impact of providing information, trial results and support to patients in phase I and II anti-cancer drug trials at trial conclusion

This paper presents qualitative findings from a three year study which set out to develop and test a nurse-led strategy for improving the management of the conclusion of patients’ participation in early cancer clinical trials. Most previous research has concentrated on recruitment, obtaining informed consent, and ensuring participation in trials. This study focused on the management of trial conclusion, a neglected area. The strategy (trial exit interviews, written information and telephone follow-up) was evaluated through a randomised controlled trial that assessed its impact on, and effectiveness in improving, the trial conclusion experience. Outcome measures were patient perceptions of trial participation and conclusion, patients’ knowledge and understanding, psychological distress, satisfaction with the intervention and adjustment to no longer being in a trial. Data were collected through questionnaires, standardised psychosocial and patient-satisfaction measures, and in-depth interviews.The findings reported in this paper relate to the data collected through in-depth interviews. The interview data showed that patients in the intervention group expressed fewer fears of abandonment at the conclusion of the trial, they appreciated being given feedback about the trial in which they had participated, expressed satisfaction with the exit interview, and derived a feeling of support from the follow-up telephone call. These findings support and illuminate other quantitative findings that we have reported elsewhere (Cox et al., 2005) and demonstrate that low cost, simple interventions can be effectively incorporated into practice.     

急诊青木春夫式断流术治疗胃底、食管静脉曲张破裂出血--附31例报告

目的　总结急诊青木春夫式断流术治疗胃底、食管静脉曲张静脉破裂出血的效果。方法　对 3 1例行急诊青木春夫式断流术的患者临床资料进行回顾性分析。结果　急诊手术止血率10 0 %。本组手术死亡 1例 ( 3 .2 % ) ,早期术后并发症发生率 9.7% ,均经非手术治愈。 2 8例获远期随访 ( 3个月 -5年 )。其中死亡 1例 (占随访数的 3 .6% ) ;门脉高压性胃病 9例 (占随访数 3 2 .1% ) ;未见再出血。结论　本术式操作简单、安全可靠 ,疗效满意 ,并发症少 ,是基层医院治疗门脉高压胃底、食管下段静脉曲张破裂大出血的理想术式。