SURGICAL TECHNIQUE Research Papers - Academia.edu (original) (raw)

Background: Rejuvenation of the lower eyelid often requires tightening of excess skin and muscle and removal or transposition of orbital fat. Although transcutaneous lower blepharoplasty can accomplish these aesthetic demands, it has been associated with an increased risk of lower lid malposition. Routine lateral canthal support during lower blepharoplasty has recently been advocated to minimize this risk. This study reviewed the outcome of a surgeon's 10-year experience with primary lower transcutaneous blepharoplasty and lateral canthal support consisting of canthopexy, canthoplasty, and orbicularis suspension. Methods: A retrospective chart review of a primary lower transcutaneous blepharoplasty series over a 10-year period was performed. Patients with a history of prior eyelid surgery for blepharoplasty or midface lift were excluded. Preoperative demographic and morphological data from patient charts and standardized photographs obtained before and after surgery were evaluated by an independent observer. Surgical technique and management of complications were determined from operative reports and clinical notes. Results: There were 264 patients with a median follow-up of 264 days (range, 60 to 2410 days). Lid malposition requiring operative correction occurred in nine patients (3.5 percent). Additional complications included orbital hematoma in one patient (0.4 percent), chemosis in 32 patients (12.1 percent), and blepharitis in 10 patients (3.8 percent). Minor surgical revisions unrelated to lid malposition were performed on 31 patients (11.7 percent) for correction of subciliary incision cysts or granulomas, canthal suture inflammation, and canthal webbing. Conclusions: Lateral canthal support should be considered a routine component of lower transcutaneous blepharoplasty to obtain the desired aesthetic result and maintain the natural appearance of the eyelid shape. The associated complication rate is acceptable. (Plast. Reconstr. Surg. 121: 241, 2008.)

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- Surgery, Treatment, Primary, Plastic and Reconstructive Surgery

Objective: Valve repair for aortic insufficiency requires a tailored surgical approach determined by the leaflet and aortic disease. Over the past decade, we have developed a functional classification of AI, which guides repair strategy and can predict outcome. In this study, we analyze our experience with a systematic approach to aortic valve repair.

- by Alain Poncelet and +2
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- Treatment Outcome, Adolescent, Child, Young Adult

Repair of the VA has evolved in the last decade. It began as an uncommon operation used in a minute percentage of patients with cerebrovascular disease. At that time many neurologists and vascular surgeons viewed these reconstructions with skepticism, doubting that they could influence the neurologic outcome of these patients or even if they were needed at all.

- by Ramon Berguer
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- Vascular Surgery, Cerebrovascular Disease, Follow-up studies, Diagnostic Imaging

Background: Grafting the floor of the maxillary sinus has become the most common surgical intervention for increasing alveolar bone height prior to the placement of endosseous dental implants in the posterior maxilla. Outcomes of this procedure may be affected by specific surgical techniques, simultaneous versus delayed implant placement, use of barrier membranes over the lateral window, selection of graft material,

- by Stephen Wallace
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- Dental Implants, Consensus, Maxilla, Systematic review

We performed a retrospective study of 19 patients who had been operated on for hepatic hydatid disease with diaphragmatic or transdiaphragmatic (D-TD) thoracic involvement chosen from a total of 444 patients who underwent operations for hepatic hydatid disease. In all cases D-TD involvement was confirmed by ultrasonography, CT, or MRI scan. We propose a new classification (grades 1–5) based on the degree of development of D-TD involvement. Before 1984 exposure was obtained by thoracophrenolaparotomy (nine cases) and later by right subcostal incision. Only four patients required atypical pulmonary resection. In 13 cases the diaphragm was repaired, and all 24 hepatic cysts were treated with total (16 cases) or partial (8 cases) cystopericystectomy. There was no operative mortality, and the most serious morbidity consisted of a biliary fistula and a biliobronchial fistula. For treatment of these patients we recommended right subcostal incision and total or near-total cystopericystectomy as a first choice of surgical technique. Nous avons étudié rétrospectivement 19 patients opérés pour une hydaditose hépatique s'étendant soit vers le diaphragme, soit vers le thorax par extension transdiaphragmatique (TD) dans une série de 444 patients ayant été opérés. Dans tous les cas de TD, le diagnostic a été confirmé par l'échographie, la tomodensitométrie ou la résonance magnétique nucléaire. Nous proposons une nouvelle classification (grades 1 à 5), basée sur le degré de TD. Avant 1984, une thoracophrénolaparotomie a été la voie d'abord préférée (9 cas) puis on a utilisé la voie souscostale droite. Seulement quatre patients ont nécessité une résection pulmonaire atypique. Chez 13 patients, on a réparé immédiatement le diaphragme et tous les kystes hydatiques hépatiques (n=24) ont été traités par une périkystectomie soit totale (16 cas) soit partielle (8 cas). Il n'y a eu aucun décès et la complication la plus grave observée a été une fistule biliaire et bilio-bronchique. Nous recommandons la périkystectomie totale ou presque totale par une incision sous-costale droite prolongée chez ces patients. Hemos realizado un estudio retrospectivo de 19 pacientes operados por enfermedad hidatídica hepática con extensión diafragmática o transdiafragmática (E-TD) al toráx, dentro de un total de 44 pacientes sometidos a cirugía por enfermedad hidatídica del hígado. En la totalidad de los casos la extensión E-TD fue confirmada por ultrasonografía, TAC o resonancia magnética. Proponemos una nueva clasificación (grados 1 a 5) basada en el grado de desarrollo de la extensión E-TD. Con anterioridad a 1984, se hizo la exposición mediante toracofrenolaparotomía (9 casos) y más tarde por incisión subcostal derecha. Sólo 4 pacientes requirieron una resección pulmonar atípica. En 13 casos el diafragma fue reparado y todos los 24 quistes hepáticos fueron tratados mediante cistopericistectomía total (16 casos) o parcial (8 casos). No se registró mortalidad operatoria y la morbilidad más seria consistió en una fístula biliar y una broncobiliar. Para el tratamiento de este tipo de pacientes nosotros recomendamos una incisión subcostal derecha y una cistopericistectomía total o casi total como la técnica quirúrgica de primera escogencia.

- by Ramon Gomez
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- World, Ultrasonography, Follow-up studies, Diagnostic Imaging
- by Artor Niccoli Asabella
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- High Pressure, Quality of life, Treatment Outcome, Constipation

Objectifs.-Les ruptures du ligament scapholunaire sont responsables d'une instabilité scapholunaire puis d'une arthrose radiocarpienne. De nombreuses techniques chirurgicales ont été décrites sans qu'aucune ne montre sa supériorité. L'objectif de notre étude est d'évaluer les résultats sur la symptomatologie clinique des capsulodèses au ligament scaphotriquétral dans le cadre de l'instabilité scapholunaire débutante. Méthodes.-Notre étude rétrospective comprend 28 patients, 22 hommes pour six femmes, de moyenne d'âge 37,8 ans, opérés entre janvier 2006 et décembre 2008, avec un délai moyen entre le traumatisme et l'intervention de 9,9 mois. Un signe de Watson était positif chez 26 patients. Tous les patients ont eu un bilan d'imagerie complet comprenant des radiographies du poignet statiques, dynamiques et un arthroscanner. Les patients inclus dans l'étude présentaient une instabilité scapholunaire statique ou dynamique. Une capsulodèse au ligament scaphotriquétral selon Berger a été pratiquée ainsi qu'une dénervation partielle du poignet systématique. Résultats.-À la révision, avec un recul moyen de 24 mois, nous constatons une diminution significative des mobilités actives du poignet avec une perte modérée de flexion de 11 % et une diminution de l'arc de mobilité du poignet de 138. La force musculaire postopératoire était augmentée. La stabilité du poignet était améliorée chez 26 patients ne présentant aucun signe de Watson postopératoire. La douleur postopératoire mesurée avec une échelle visuelle analogique (Eva) était notée à 2,4 (p < 0,005). Vingt et un patients ont repris leur activité professionnelle sans adaptation de leur poste de travail alors que dans 67 % des cas, il s'agissait de travailleurs manuels. Dans notre série nous avons observé deux complications : une algodystrophie et une arthrite. Conclusion.-De nombreuses techniques ont été décrites pour le traitement des lésions scapholunaires, du simple brochage scapholunaire aux arthrodèses partielles intracarpiennes. Notre série montre que la capsulodèse réalisée à l'aide de la moitié proximale du ligament scaphotriquétral améliore la symptomatologie clinique des instabilités scapholunaires débutantes.

- by Thierry Dubert
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- Art, Medicine, Osteoarthritis, Retrospective Studies

Controversy still exists about the optimal surgical treatment of rectal cancer. The main purpose of the present study was to compare local recurrence (LR) rates after mesorectal excision (ME) and conventional surgery (CS) technique. Methods: All rectal cancer patients from a defined catchment area were included. Outcome after ME in the period 1993-1999 (n=161) was compared with the outcome after CS (n=217) in the period 1983-1992. Partial ME (PME) was the routine in upper, and total ME the routine in mid-and low rectal cancer. The follow-up programmes were identical, and the median observation times very similar (37 and 38 months) in the two periods. Five-year actuarial LR rate and survival were estimated using the Kaplan-Meier method, and adjustment for prognostic factors was performed with Cox regression analysis. Results: Total LR rate after R0 resection was 7.7% crude and 9% 5 year actuarial in the ME period, as compared with 16.0% crude and 24% actuarial in the CS period (P=0.02). Cox regression analyses confirmed these differences with a hazard ratio of 0.40 for ME vs CS (P=0.02). Isolated LR rate was 2% after ME and 8% after CS. Five-year actuarial total LR rate after rectal resection with curative intent was 11% after ME and 27% after CS (P<0.01). Actuarial total LR rate after PME was 6%, and none of these patients developed isolated LR. Conclusion: Standardization of surgical technique and application of ME resulted in a significant reduction of LRs. LR rate was low after PME, indicating that this procedure is adequate in upper rectal cancer.

- by Ola Westerheim
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- Treatment Outcome, Prospective studies, Cox Regression, Follow-up studies

Patients with chronic detrusor acontractility caused by a lower motor neuron lesion typically require lifelong clean intermittent catheterization-with all its inherent long-term risks-to empty their bladder. Latissimus Dorsi Detrusor Myoplasty is a sophisticated surgical technique of free neurovascular transfer of the latissimus dorsi muscle that is anchored to osseous and fascial structures around the bladder to restore voluntary voiding. Following several experimental studies, the first report of the clinical applicability demonstrating complete restoration of voluntary voiding in three patients with bladder acontractility was reported in 1998. In 2003, the first long-term data proved the viability of the procedure. The current long-term data from a multicenter analysis underline once more the potency of successfully restoring bladder emptying in acontractile bladder via latissimus dorsi detrusor myoplasty.

- by Gustavo Sturtz
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- Motor neuron, Experimental Study, SURGICAL TECHNIQUE, Clinical Application

Purpose: Posterior transverse plication (PTP) has gained popularity as a technique to correct redundancy of the internal carotid artery during endarterectomy. The safety of this technique in large series of patients has not been extensively studied. We investigated 876 primary carotid endarterectomies (CEAs) performed at our institution over the last six years to determine the safety of this technique.

- by S. Salles-Cunha
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- Cardiovascular, Treatment Outcome, Ultrasound, Ultrasonography

Background. The functional benefits of mandibular reconstruction following a composite resection remain unclear. Although microvascular surgical techniques have dramatically increased the predictability of bone and soft-tissue reconstruction towards presurgical anatomic norms, the specific factors responsible for improved function remain controversial. Objective measures of masticatory function need to be more clearly determined before the predictability and efficacy of reconstructive approaches is established.

- by arun b
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- Dentistry, Diet, Bite force, Mandible

The 1970s saw an explosion of ideas in the field of prosthetic knee arthroplasty. This paper is an effort to identify the innovators who contributed to the development of today's condylar total knee prostheses and the surgical techniques used to insert them. The 1970s were selected because most innovations occurred during those years. Two different design approaches were undertaken simultaneously. One was a functional approach whereas the other was a strictly anatomical approach. Initially, these 2 approaches led to very different designs. But the common goal of recreating human knee function eventually led to more similarities than differences. The author describes how, when, and why these dedicated individuals came to their ideas. The work is largely based on interviews and correspondence with those involved as well as on reviews of patents and papers pertaining to their work.

- by Raymond Robinson
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- Biomedical Engineering, Arthroplasty, Clinical Sciences, SURGICAL TECHNIQUE

OBJECTIVE: Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. With the availability of new diagnostic procedures these tumors have been more precisely studied and questions of whether, when, and how these lesions should be treated often arise. Data from 106 consecutive patients surgically treated in the past 17 years were retrospectively analyzed to identify surgical outcomes. METHODS: The tumors were approached by a multidisciplinary team composed of neurosurgeons, ear, nose, and throat surgeons, and neuroradiologists. Hypervascular lesions were embolized 3 to 5 days before surgery. The same surgical technique was used to resect all tumors. The surgical defect was covered with vascularized myofascial flaps. The internal carotid artery was infiltrated in two patients, and a saphenous graft bypass was carried out before removal of the lesions. The facial nerve was reconstructed with nerve grafts (great auricular nerve) or XII/VII anastomosis in five cases. Postoperative radiotherapy was carried out for malignant and invasive tumors. RESULTS: Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. Complete excision was possible in 89% of benign tumors and 80% of paragangliomas. Lower cranial nerve deficit was the most frequent complication (10 patients, 9.4%), transient in 4 patients. Facial and cochlear nerve paralysis occurred in 8 patients (7.5%). The function of the facial nerve recovered spontaneously in 3 patients. Four patients (3.7%) developed postoperative cerebrospinal fluid leakage. Four patients (3.7%) died after surgery. CONCLUSION: Radical removal of benign jugular foramen tumors is the treatment of choice and may be curative. Large lesions can be radically excised in one surgical procedure with preservation of lower cranial nerves. Cranial base reconstruction with vascularized myofascial flaps reduces the incidence of postoperative cerebrospinal fluid leakage. Damage of the lower cranial nerves is the most serious surgical complication.

- by Mauricio Neto
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- Neurosurgery, Treatment Outcome, Adolescent, Cerebrospinal Fluid

Background: Colorectal surgery has evolved significantly during the last 35 years. The circular stapler and the double stapler techniques have favored the development of very low rectal anastomoses with reduction in anastomotic leakage. The objective of this study is to evaluate the functional results and complication rate of this surgical technique in the

- by Moises Ruiz
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- Treatment Outcome, Ulcerative colitis, Mexico City, Risk factors

Cataract surgery is routinely performed under local anaesthesia. With modern surgical techniques, adequate operating conditions can often be provided by topical anaesthesia alone. For more complex procedures and for prolonged operations such as vitreo-retinal surgery a local block is required. Historically, the sharp needle techniques of retrobulbar and peribulbar eye block have been used. However, the occurrence of rare but sight-threatening complications such as retrobulbar haemorrhage and globe perforation have led to the adoption of the technique of sub-Tenon's block, which avoids the use of sharp needles. A thorough knowledge of ocular anatomy is essential before proceeding with any eye block technique. Patients who receive local anaesthesia for ocular surgery require careful preoperative assessment and stabilization of concomitant medical conditions. The intended procedure should be explained to the patient to ensure their cooperation and reduce anxiety.

- by Caroline Carr
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- Cataract surgery, Anaesthesia, Clinical Sciences, Eye

E ssential tremor (ET) is a common movement disorder among the elderly affecting approximately 5% of people older than the age of 60. The tremor most commonly involves the upper extremities, although involvement of the legs, head, and voice is also described. The tremor is present at rest but is exacerbated by purposeful movement or stress, causing severe disability, particularly if it affects the dominant hand. There is no cure for ET, but medications such as propranolol, primidone, benzodiazepines, and botulinum toxin injections may successfully alleviate symptoms in 50% of patients. 1 When med-ications fail, surgical options include deep brain stimulation (DBS) or thalamotomy directed toward the Vim/Vop subnuclei of the ventrolateral nucleus. DBS is associated with less morbidity than thalamotomy, the most common side effect of stimulation being reversible dysarthria compared with permanent cognitive dysfunction and speech deficits that may be observed after thalamotomy. 2,3 Several case series demonstrate that more than 80% of patients who undergo DBS surgery experience tremor relief, even after 6 years. As medical technologies advance, increasing numbers of DBS candidates will already have implanted medical devices including cardiac pacemakers/defibrillators, spinal cord stimulators, and others. It is therefore important to know NE UROSURGERY OBJECTIVE: Deep brain stimulation (DBS) has become routine for the treatment of Parkinson's disease and essential tremor. Because both of these disorders are common in patients older than the age of 60, neurosurgeons are likely to encounter increasing numbers of patients who require DBS surgery but who already have another electronic medical implant such as a cardiac pacemaker/defibrillator or intrathecal infusion pump, raising the concern that one device might interfere with the performance of the other. CLINICAL PRESENTATION: Herein we report a modification of surgical technique resulting in the successful use of thalamic DBS to treat disabling essential tremor in a man with a previously implanted cochlear implant.

- by Michele Tagliati
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- Neurosurgery, Deep Brain Stimulation, Treatment Outcome, Thalamus

Résumé But de l'étude. -L'allogreffe d'îlots de Langerhans représente une alternative potentielle à l'insulinothérapie chez les patients atteints de formes sévères de diabète de type 1. Nous rapportons ici notre expérience du prélèvement... more

Background/Purpose: The purpose of this study was to review the authors' 25-year experience with redo pullthrough procedures for Hirschsprung's disease including surgical technique and long-term outcome. Methods: From 1974 to now, over 325 patients with Hirschsprung's disease have been treated at C.S. Mott Children's Hospital. This includes 30 patients referred after an unsuccessful pull-through at another hospital and 2 patients with an unsuccessful pull-through from C.S. Mott. All redo pull-throughs (n ϭ 19) were performed in these patients, and their clinical courses are reviewed. Results: Twelve patients required reoperation secondary to a mechanical problem with their first pull-through. The other 7 patients had evidence of residual segments of dilated colon leading to functional failure of their initial operation including 5 patients with documented aganglionic bowel present at the second pull-through. Ten of the patients requiring reoperation initially had an endorectal pull-through (ERPT), 5 had a Duhamel procedure, 3 had a Swenson procedure, and 1 had a Rehbein procedure. Choice of revision was an ERPT in 8 patients in whom an adequate rectal cuff could be developed. Additional redo procedures included a Duhamel in 8 patients and a Swenson in 3 patients. Follow-up ranges from 3 months to 23 years (mean, 13.8 years). There were no deaths in the series, and 1 patient required a third pull-through. All patients who are not neurologically impaired and are over age 3 are continent except one (94%). Stools per day range from 1 to 10 (mean, 3.2). Conclusions: Redo pull-through operations for Hirschsprung's disease appear to be as effective as primary procedures in terms of continence and stooling frequency. Distinct from other series, we found an ERPT to be the procedure of choice if an adequate rectal cuff was present.

- by Essam Elhalaby
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- Adolescent, Medicine, Child, Pediatric Surgery
- by Albert Chin
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- Endoscopy, Animal Model, Dissection, Risk factors

Introduction. To eliminate mortality and morbidity risk in living related liver donors, we developed a new surgical technique to resect hepatic parenchyma using an ultrasonic surgical aspirator in association with a monopolar floating ball cautery. Methods. We performed 17 right hepatectomies and 2 left hepatectomies using this technique. We performed a retrospective analysis of perioperative mortality, length of hospitalization (LOS), blood transfused during surgery (IBT), intraoperative blood lost (IBL), biliary complications (BC), and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) peak in the first postoperative week. This group of patients (Group A) was compared, using the analysis of variance (ANOVA) test (P Ͻ .05) with 2 different groups of 19 patients: Group B with liver neoplasms that had the same technique as Group A, and Group C wherein a crushing clamp technique was used. Results. All of the analyzed variables showed significative statistical differences, especially between Group A and Group C (IBL, P Ͻ .000; IBT, P Ͻ .006; LOS, P Ͻ .028; BC, P Ͻ .000; AST peak, P Ͻ .041; and ALT peak, P Ͻ .023). Discussion. The association of these 2 techniques seems to reduce the LOS, and the need for intraoperative blood transfusions. Moreover, the surgical complications (biliary leaks) and the postoperative parenchymal cytonecrosis seem to be less using this technique.

- by Bruno Gridelli
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- Family, Transplantation, Liver Transplantation, Length of Stay

Background The transaxillary breast augmentation (TBA) technique has gained popularity because of several advantages. However, the impact of the procedure on breast lymphatic drainage and sentinel node (SN) detection remains controversial. The objective of this study was to evaluate the lymphatic patterns and SN detection rates after TBA by using lymphoscintigraphy (LSG). Methods Twenty patients (40 breasts) who underwent TBA were evaluated by LSG immediately after periareolar injections of phytate-99 mTc at three time points: before TBA (Pre-LSG) and approximately 30 days (Recent-Post-LSG) and 6 months after TBA (Late-Post-LSG). Statistical analysis considered p \ 0.05 significant, or p \ 0.017 when Bonferroni correction was applied. Results All breasts drained primarily to the axillary SN. The binomial test did not show statistical differences in lymphatic drainage patterns between Pre-LSG and Recent-Post-LSG (p = 1), Pre-LSG and Late-Post-LSG (p = 0.625), and Recent-Post-LSG and Late-Post-LSG (p = 0.625). The average number of hot SN was 1.28 in Pre-LSG, 1.10 in Recent-Post-LSG, and 1.23 in Late-Post-LSG, without significant differences (p = 0.202). The average time of the first SN appearance was not significantly different (p = 0.186). Analysis of SN uptake percentage showed a significant difference between Pre-LSG and Recent-Post-LSG (p = 0.009), with a reduction of drainage magnitude in Recent-Post-LSG. Conclusion The preservation of axillary lymphatic drainage after TBA allowed for SN detection in all studied breasts. It seems that the applied surgical technique played an important role in axillary lymphatic integrity.

- by Heitor Sado
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- Nonparametric Statistics, Statistical Analysis, Treatment Outcome, Risk assessment
- by Thomas Hartung
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- Biomaterials, Cryopreservation, Multidisciplinary, Lipopolysaccharide

Choanal stenosis has recently been recognized as a late complication of radiation therapy for nasopharyngeal carcinoma. The management of velopharyngeal stenosis is challenging with high risk of restenosis. We report a case of velopharyngeal stenosis post-radiotherapy and illustrated the use of mitomycin-C to prevent restenosis. Mitomycin-C application has being shown useful adjunct to surgical technique in managing nasopharyngeal stenosis for surgeons. #

- by Selvan Kumar
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- Radiation Therapy, Stents, Follow-up studies, Recurrence

The use of lateral mass atlas screws is an important technique to achieve fusion and stability at the craniocervical region affected by different pathologies (degenerative, traumatic, inflammatory, neoplastic, or congenital). This paper describes the anatomy and techniques necessary for proper insertion of posterior C1 lateral mass screws, using anatomic dissection and intraoperative pictures. Knowledge of the anatomy and the surgical technique of insertion of C1 lateral mass screws are of paramount importance to have good surgical results.

- by Helder Tedeschi
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- Surgery, Skeletal muscle biology, Anatomy, Atlas

The APTOS threading procedure is a relatively new method in antifacial ptosis surgery. The reported cases present a small percentage of minor complications. A 57year-old woman experienced scarring after APTOS threading. Scar biopsy showed an epidermoid inclusion cyst. Epidermoid inclusion cysts are a potential complication of APTOS threading. Proper surgical technique may reduce their likelihood.

- by Eyal Winkler and +1
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- Case Report, Clinical Sciences, SURGICAL TECHNIQUE
- by dante bollini
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- X Rays, Room Temperature, SURGICAL TECHNIQUE, X-ray Detector

Although techniques for the perioperative management of patients undergoing mitral valve replacement have been well established in humans, the use of these techniques has not been widely accepted in veterinary practice. The purpose of this study is to demonstrate that low morbidity and mortality could be achieved in the dog undergoing mitral valve replacement. Nine mongrel dogs (25-45 kg body weight) were subject to left thoracotomy and mitral valve replacement using cardiopulmonary bypass (CPB). The average time on CPB was 1 hour with an aortic cross-clamping time of 40 minutes using chemically induced cardiac arrest. CPB was performed under conditions of moderate systemic hypothermia (28-30" C) and hemodilution (hematocrit, 25-35%). Operative mortality was 22% (2/9) with one death from excessive bleeding and the other from cerebral air embolism. All other animals recovered and were clinically normal 3 weeks after surgery. The authors conclude that successful mitral valve replacement is possible in the large dog.

- by Giannoula L Klement
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- Dogs, Veterinary Surgery, Mitral Valve Repair, SURGICAL TECHNIQUE

Objective: Controversy still exists regarding the optimal surgical technique for postinfarction left ventricular (LV) aneurysm repair. We analyze the efficacy of two established techniques, linear vs. patch remodeling, for repair of dyskinetic LV aneurysms. Methods: Between May 1988 and December 2001, 110 consecutive patients underwent repair of LV aneurysms. These represent 2.0% of a total group of 5429 patients who underwent isolated CABG during the period. Seventy-six (69.1%) patients were submitted to linear repair and 34 (30.9%) to patch remodelling. There were 94 (84.5%) men and 17 women, with a mean age of 59.2G9.2 years. Coronary surgery was performed in all patients (mean no. of grafts/patient, 2.7G0.8) and 14 (12.7%) had associated coronary endarterectomy. Forty-four (40.0%) patients had angina CCS class III/IV (linear 43.4%, patch 32.4%, NS) and the majority was in NYHA class I/II (88.2% in both groups). Left ventricular dysfunction (EFO40%) was present in 72 (65.5%) patients (linear 61.8%, patch 73.5%, NS). Results: There was no perioperative mortality, and major morbidity was not significantly different between linear repair and patch repair groups. During a mean follow-up of 7.3G3.4 years (range 4-182 months) 14 patients (14.3%) had died, 12 (85.7%) of possible cardiac-related cause. Actual global survival rate was 85.7%. Actuarial survival rates at 5, 10 and 15 years were 91.3, 81.4 and 74%, respectively. There was no significant difference in late survival between the patch and the linear groups. At late follow-up the mean angina and NYHA class were, 1.3 (preoperative 2.4, P!0.001) and 1.5 (preoperative 1.7, NS), respectively, with no difference between the groups. There was no significant difference in hospital readmissions for cardiac causes (linear 22.8% and patch 37.0%). Conclusions: The technique of repair of postinfarction dyskinetic LV aneurysms should be adapted in each patient to the cavity size and shape, and the dimension of the scar. Both techniques achieved good results with respect to perioperative mortality, late functional status and survival. q

Parkinson's disease (PD) affects one in every 100 persons above the age of 65 years, making it the second most common neurodegenerative disease after Alzheimer's disease. PD is a disease of the central nervous system that leads to severe difficulties with body motions. The currently available therapies aim to improve the functional capacity of the patient for as long as possible; however they do not modify the progression of the neurodegenerative process. The need for newer and more effective agents is consequently receiving a great deal of attention and consequently being subjected to extensive research. This review concisely compiles the limitations of currently available therapies and the most recent research regarding neuroprotective agents, antioxidants, stem cell research, vaccines and various surgical techniques available and being developed for the management of PD.

- by Neha Singh
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- Cognitive Science, Deep Brain Stimulation, Vitamins, Drug delivery

E U R O P E A N U R O L O G Y 5 7 ( 2 0 1 0 ) 1 0 3 9 -1 0 4 4 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Background: Despite... more

E U R O P E A N U R O L O G Y 5 7 ( 2 0 1 0 ) 1 0 3 9 -1 0 4 4 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Background: Despite improvements in surgical techniques, urinary incontinence (UI) is not uncommon after radical prostatectomy (RP), and it may dramatically worsen quality of life (QoL). Objective: To determine the benefit of starting pelvic floor muscle exercise (PFME) 30 d before RP and of continuing PFME postoperatively for early recovery of continence. Design, setting, and participants: A randomised, prospective study was designed. Men with localised prostate cancer (PCa) who underwent an open radical retropubic prostatectomy (RRP) at our department of urology were included. Intervention: Patients were randomised to start PFME preoperatively and continue postoperatively (active group: A) or to start PFME postoperatively alone (control group: B). Measurements: The primary outcome measure was self-reported continence after surgery. Secondary outcome measures were assessed by degree of UI based on a 24-h pad test and QoL instruments (International Continence Society [ICS] male short form [SF]). Results and limitations: Of 143 men evaluated for the study, 118 were randomised either to start PFME preoperatively and continue postoperatively (group A; n = 59) or to start postoperative PFME (group B; n = 59). After 1 mo, 44.1% (26 of 59) of patients were continent in group A, while 20.3% (12 of 59) were continent in group B ( p = 0.018). At 3mo, 59.3% (35 of 59) and 37.3% (22 of 59) patients were continent in group A and group B, respectively ( p = 0.028). The ICS male SF mean score showed better results in group A than in group B patients at both 1 mo (14.6 vs 18.3) and 3 mo (8.1 vs 12.2) after RP ( p = 0.002). In age-adjusted logistic regression analyses, patients who performed preoperative PFME had a 0.41-fold lower risk of being incontinent 1 mo after RP and a 0.38-fold lower risk of being incontinent 3 mo after RP ( p 0.001). Conclusions: Preoperative PFME may improve early continence and QoL outcomes after RP. Further studies are needed to corroborate our results.

- by Giorgio Guazzoni
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- Quality of life, Treatment Outcome, Exercise therapy, Urinary incontinence
- by Naveen Garg
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- Cardiology, Adolescent, Child, Hemodynamics

The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

- by M. Manring
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- Ancient History, Military History, Military Medicine, Medieval History

tomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevertheless, a competently performed Whitehead's hemorrhoidectomy can give satisfying results. These results are explained by improved knowledge of the anatomy of the anal region and a more accurate surgical technique. On the basis of our experience we believe that Whitehead's hemorrhoidectomy still has its place in selected cases with precise indications.

- by Giuseppe Brisinda
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- Treatment Outcome, Recurrence, Clinical Sciences, SURGICAL TECHNIQUE

Iatrogenic hallux varus is a possible complication of hallux valgus surgery following Mc Bride or Scarf osteotomy, with or without Akin osteotomy of the first phalanx. It may also occur following chevron osteotomy or Keller's procedure. One possibility for surgical revision of iatrogenic hallux varus is recon- struction of the lateral stabilising soft-tissue compo- nents of the first metatarsophalangeal joint.

- by Pierre-louis Docquier
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- ACTA, SURGICAL TECHNIQUE, Soft Tissue, Iatrogenic Disease

we performed THD in 330 patients (180 men; mean age, 52.4 years), including 138 second-degree, 162 thirddegree and 30 fourth-degree haemorrhoids. There were 23 postoperative complications (7 cases of bleeding, 5 thrombosed piles, 4 rectal haematomas, 2 anal fissures, 2 cases of dysuria, 1 of haematuria and 2 needle ruptures). The mean postoperative pain score was 1.32 on a visual analog scale. 219 patients were followed for a mean of 46 months (range, 22-79), including 100 patients with second-degree, 104 with third-degree and 15 with fourth-degree haemorrhoids. The operation completely resolved the symptoms in 132 patients (92.5%) with preoperative bleeding and in 110 patients (92%) with preoperative prolapse. Conclusions The efficacy and relapse rate of this procedure appears to be similar to that of traditional surgery and stapled haemorrhoidopexy. The technique was effective and safe for all degrees of haemorrhoids because of the excellent results, low complication rate and minor postoperative pain.

Purpose Treatment of anal fistulas by use of adhesives is an attractive method because of its simplicity and it can be performed on an ambulatory basis. Furthermore, if the treatment is unsuccessful, adhesive use does not subsequently prevent the surgeon from utilizing alternative surgical techniques and/or products. BioGlue® Surgical Adhesive is a two-component surgical adhesive composed of bovine serum albumin and glutaraldehyde. We evaluated the usefulness of BioGlue® for the treatment of high transsphincter anal fistulas. Methods Patients diagnosed with high transsphincter anal fistulas of cryptoglandular origin, whether relapsed or not, were included in this study. A seton was placed before the injection of BioGlue® into the fistula track of high transsphincter anal fistulas in patients with secondary tracts and/or purulent collections. Clinical charts, operative reports, and endoanal echography results obtained for each patient were reviewed. Results Fourteen patients (13 males; mean age, 39.9 (range, 24–66) years) with high transsphincter anal fistulas of cryptoglandular origin were recruited into the study. The average time of symptom evolution was 35.6 (range, 2–96) months. Ten of 14 cases were for relapsed fistulas. Six patients required the placement of a seton 37 (range, 32–42) days before the BioGlue® injection. Patients were followed for a mean length of 13.92 (range, 3–21) months, and the fistula healed completely in only seven patients (50 percent). Conclusions These preliminary results demonstrate that BioGlue® may be useful for treating patients with high transsphincter anal fistulas. Further prospective long-term studies are needed.

- by Eduardo Espinosa
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- Wound Healing, Treatment Outcome, Proteins, Clinical Sciences

Aim of the study was to get more insight into the opinion of European surgeons and orthodontists on the use of distraction osteogenesis (DO) for patients with different diagnoses and treatment protocols. A web based survey was set up, showing records of four patients with different conditions: hemifacial microsomia (case 1), bilateral mandibular deficiency (case 2), cleft lip and palate (case 3) and Crouzon syndrome (case 4). Respondents from 181 Eurocleft centres were asked to fill out a questionnaire for each patient. Most of the respondents considered case 1 (80%), case 3 (81%) and case 4 (86%) suitable for DO, while only 31% were considering case 2 for DO. There was lack of consensus among the respondents about many aspects of DO. Out of six different treatment parameters, an acceptable degree of agreement was only seen in two: a latency period of 3e7 days and a distraction rate of 1 mm per day. Furthermore, there was noticeable disagreement on the ideal age for treatment, surgical technique, distraction device, and retention period. Our results showed that there is a wide variety in treatment approaches for craniofacial anomalies in Europe. There is disagreement on essential steps in the distraction procedures. Ó 2009 European Association for Cranio-Maxillo-Facial Surgery

- by Wilfred Borstlap
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- Dentistry, Orthodontics, Cleft Palate, Cleft Lip and Palate
- by Remah Kamel
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- Wound Healing, Prevention, Literature Review, Complementary Medicine

The gold standard of bone grafting is harvesting autologous cortical and cancellous bone from the iliac crest, the most common source of autogenous bone graft. However, it has been suggested that, in coming years, other alternatives will be more effective, gradually diminishing the current role of this autologous graft. Harvesting of the iliac crest is not always without complication, and significant donor site morbidity must be considered in different surgical procedures, including pain, abnormal sensation, nerve injury, haematoma, infection, wound dehiscence, ilium fracture, pelvic instability, dislocation of the sacro-iliac joint, enterocutaneous fistula, arteriovenous fistula, abdominal hernia, and hypertrophic scar. There have been few reports on methods to reconstruct defects at the iliac donor site, and these are often done as secondary procedures. Successful primary reconstruction of large osseous defects of the ilium by using customized titanium plates 10 after harvest of composite flaps have been reported, and also by means of moulded metal plates with screws. 12 Primary closure using mesh has been proposed for the elderly, obese and those patients with poor muscular development, especially if the resulting bone defect is larger than 4 Â 4 cm. A method of primary anterior iliac crest reconstruction was reported by Defino and Rodriguez-Fuentes, 6 by using one of the patient's own ribs which is removed during an anterior surgical approach to the spine in patients submitted to thoracotomy or thoracolumbotomy for spinal arthrodesis. They reported good clinical results in 15 patients, who were satisfied with the cosmetic appearance of the reconstruction. We describe a similar simple method of primary reconstruction of the bone defect in the donor site, by means of a transversal fence of appropriate thin tricortical chips obtained from the lateral walls of the bone defect itself. Our preliminary experience in children has been satisfactory.

- by Jorge Gil-Albarova
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- Nursing, Osseointegration, Bone graft, Child

Heart disease is a major cause of death in the Western world. In the past three decades there has been a number of improvements in artificial devices and surgical techniques for cardiovascular disease; however, there is still a need for novel devices, especially for those individuals who cannot receive conventional therapy. The major disadvantage of current artificial devices lies in the fact that they cannot grow, remodel, or repair in vivo. Tissue engineering offers the possibility of developing a biological substitute material in vitro with the inherent mechanical, chemical, biological, and morphological properties required in vivo, on an individual patient basis. In order to develop a true biological cardiovascular device a dynamic physiological environment needs to be created. One approach that employs the use of a simulated biological environment is a bioreactor in which the in vivo biomechanical and biochemical conditions are created in vitro for functional tissue development. A review of the current state of the art bioreactors for the generation of tissue engineered cardiovascular devices is presented in this study. The effect of the simulated physiological environment of the bioreactor on tissue development is examined with respect to the materials properties of vascular grafts, heart valves, and cardiac muscles developed in these bioreactors.

- by Abhay Pandit
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- Engineering, Biomedical Engineering, Tissue Engineering, Biomimetics

We report 2 cases of right pulmonary aplasia with left pulmonary artery sling responsible for severe respiratory symptoms. Repositioning of the left pulmonary artery without tracheal surgery was successful in both patients. The postoperative course was simple, and the outcome was favorable at last follow-up (after 2 years and 3 months, respectively). Computed tomography provided an accurate diagnostic evaluation that helped to choose the best surgical technique.

- by Charlotte Pierron
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- Computed Tomography, Kidney, Pediatric Surgery, Pediatric

The foundations of the generally accepted principles underlying the surgical management of renal cell carcinoma (RCC) were best annunciated in 1969 by Robson in his classic description of the radical nephrectomy [J Urol 1969;101;297]. Since then, much has changed in our understanding of the basic biology and genetics of kidney cancer, advances in renal imaging and clinical staging have led to the increased detection of incidental, lower stage, organ-confined tumors more amendable to expanded surgical options, surgical techniques themselves have evolved, and surgical equipment technology has advanced to make possible new methods of managing renal tumors in situ. Thus, the management of both localized and metastatic RCC has changed dramatically in the last 20 years, predicated on these major advancements in renal imaging, surgical techniques, and the development of effective immunotherapies for advanced disease. In this review, the evolution in thinking regarding the tenets of the radical nephrectomy will be examined, including the necessity for removal of the entire kidney, the possibility of sparing the adrenal gland, when and how extensive a lymphadenectomy should be performed, the development of laparoscopic and percutaneous nephron-sparing surgery using ablative technologies, and the role of nephrectomy and metastasectomy in patients with metastatic RCC. Here, we review current concepts and outcomes on the surgical management of RCC to help elucidate some of these changes, from the evolution of open to laparoscopic to percutaneous, from radical to partial to ablative approaches. #

- by Allan Pantuck
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- Genetics, Renal cell Carcinoma, Clinical Sciences, Survival Rate

Intestinal derotation (ID) is a rarely used surgical technique which allows elegant and effective surgical access to the superior mesenteric axis and third and fourth portion of the duodenum. ID proves an extremely useful technique especially in the emergency setting when access to the ''surgical soul'' is needed. To master this technique the surgeon has to become familiar with the anatomical landmarks of that area along with the embryological background.

- by Cesare Pirozzi
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- Clinical Sciences, SURGICAL TECHNIQUE, Acute Abdomen
- by Francesco Oliva
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- Nursing, Biomedical Engineering, Titanium, Adolescent

Treatment of intramedullary infections of long bones is based upon the principles of surgical debridement, irrigation, fracture site stabilization, soft tissue coverage, and antibiotic administration. Reaming of the medullary canal is an essential component of surgical debridement because it removes intramedullary debris and infected bone surrounding the removed intramedullary device and within the intramedullary canal. The Reamer-Irrigator-Aspirator (RIA) has distinct features that appear to be beneficial for management of intramedullary infections. It allows reaming under simultaneous irrigation and aspiration, which minimizes the residual amount of infected fluid and tissue in the medullary canal and the propagation of infected material. The disposable reamer head is sharp, which combined with the continuous irrigation may attenuate the increased temperature associated with reaming and its potential adverse effects on adjacent endosteal bone. The disadvantage of the RIA is increased cost because of use of disposable parts. Potential complications can be avoided by detailed preoperative planning and careful surgical technique. The RIA should be used with caution in patients with narrow medullary canals and in infections involving the metaphysis or a limited part of the medullary canal. Reaming of the canal is performed with one pass of the RIA under careful fluoroscopic control. Limited information is available in the literature on the results of the RIA for management of intramedullary infections of long bones; however preliminary results are promising. The RIA device appears to be an effective and safe tool for debridement of the medullary canal and management of intramedullary infections of the long bones. Further research is needed to clarify the exact contribution of the RIA in the management of these infections.

- by Michael Sirkin
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- Nursing, Irrigation, Treatment, Treatment Outcome