ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The techniques and cosmetic results of reduction mammaplasty have been well documented. However, pain is a major indication for undergoing this procedure, and symptom relief has rarely been addressed. This issue becomes particularly important in an era when medical costs are being increasingly scrutinized. The purpose of this study was to determine the effect of reduction mammaplasty on long-term morbidity related to chronic neck and back pain. Of 223 questionnaires distributed to patients who underwent reduction mammaplasty between 1984 and 1993, 177 questionnaires were returned. Two surgeons were involved, and all operations used the inferior pedicle technique, removing a minimum of 1,000 gm per patient. Seventy-four percent of patients were free of neck pain postoperatively versus 21% preoperatively. Similar results were obtained regarding back pain. Also 81% of those reporting severe neck or back pain before surgery currently have only mild or no pain. Analgesic use decreased from 44 to 17% (many of whom take pain medication for unrelated problems). Sixty-five percent of patients reported exercising more since surgery. Excellent patient satisfaction was confirmed as well. Breast shape and symmetry were “as expected or better.” There was improvement in self-image for 88%, and 98% would recommend the procedure to others. Our dramatic functional results, combined with patient satisfaction and minimal morbidity, underscore the efficacy of breast reduction in medically indicated (symptomatic) cases.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We propose reinforcing the abdominal wall in abdominoplasties with a polypropylene mesh over three fusiform plications. A marked degree of musculoaponeurotic reinforcement is achieved and maintained postoperatively, especially if these layers are very flaccid. Indications for the procedure and patient selection are described.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Nasal anthropometric studies were performed on 69 African- American adults (28 men and 41 women). Seven parameters were measured: nasal length, width of bridge, width of nose, protrusion, length of columella, nasolabial angle, and nasofrontal angle. Six area proportion indices were calculated from these measurements. Normal nasal measurements (defined as those within mean 2 SD) were found in 95.2% of the 483 measurements; 72.3% of the measurements were within 1 SD of the mean. The normal variation ratio ranged from 8.9 to 31.97'0, indicating great variability as a result of the triethnic origin of African-Americans. Harmonious indices (mean + 2 SD) were present in 70% of the 414 indices. Optimal indices (mean 1 SD) were present in 68.1%. The mean constituted only 1.9% of the optimal indices. Disproportionate indices (those greater than mean + 2 SD or less than mean - 2 SD) were present in 4.6%. The nasal measurements and indices were compared with those of North American Caucasians. The range of normal measurements and harmonious indices in this study define the linear parameters of the abstract concept of African-American ethnicity. Successful rhinoplasty is achieved through restoration of harmony, which is defined as optimal relationships between proportions. Our study provides those optimal values. Good preoperative measurements combined with understanding of the normal African-American nasal measurements and indices will improve aesthetic decisions at surgery and facilitate the achievement of harmony.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Six patients underwent percutaneous pin placement, 17 intraoral corticotomies, and application of an Orthofix lengthening device to facilitate complex multiplanar distraction as mandated by the patient's specific deformity. The patients underwent gradual bony and soft-tissue distraction at the rate of .25 mm four times a day. Average distraction was 18.3 + 5.5 mm (mean rt SD). After distraction, a Pday period of stabilization for each 1 mm of lengthening was used (36.4 ± 10.7 days) (M ± SD). All the patients had marked improvement in their occlusion postoperatively and significant amelioration of their preoperative respiratory and feeding difficulties. The patients all exhibited dramatic aesthetic improvement. lntraoral corticotomies performed in conjunction with gradual skeletal distraction appears to offer significant advantages over classical treatment for micrognathia in a very specific group of patients.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Calcification of soft tissue may be an unspecific local response or present as only a symptom of a complex underlying disease. Patient approach and treatment vary greatly depending on the cause of soft-tissue calcifications. The review of literature reveals multiple causes but also confusing nomenclature for similar clinical entities. Dystrophic and metastatic soft-tissue calcifications are discerned, but there is also contribution of both types of soft-tissue calcification to some syndromes. Six previously unpublished cases of soft-tissue calcification including Thibikrge- Weissenbach syndrome, scleroderma (progressive systemic sclerosis), calcifying cavernous hemangioma (2 patients), and heterotopic calcifications after burn injury (2 patients) are presented to discuss the differential diagnosis. The correct diagnosis is crucial for successful treatment. Resections of the lateral heads of the gastrocnemius muscles in 2 patients resulted in cure of the problem. The patient suffering from Thibikrge- Weissenbach syndrome had no recurrence during a 30-month postoperative follow-up period. Surgical treatment of scleroderma or soft-tissue calcification after burn injury is aimed toward relief of symptoms. A proposal for patient assessment and indications for surgical correction with regard to soft-tissue calcifications is presented and discussed.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Heparin added to irrigation solutions and used in microvascular surgery may have activity as a topical antithrombotic agent. A rat model of arterial thrombosis was used to evaluate topical heparin for preventing thrombosis. A crush injury was applied to both femoral arteries, and then they were transected and anastomosed. The vessel on one side of each rat was washed out and the wound irrigated with physiological saline containing one of three concentrations of heparin: 0, 100, or 500 Ulml. The vessel on the contralateral side was irrigated with unheparinized saline throughout. Patency rates at 24 hours were 63% (10 of 16) for vessels irrigated with either 100 or 500 Ulml of heparin. The contralateral vessels had 24-hour patencies of 19% (3 of 16) for each group (p c 0.05). The group receiving bilateral, unheparinized irrigation had a 24-hour patency of 29% (8 of 28). Activated partial thromboplastin times were significantly prolonged (p < 0.05) 20 minutes into the recirculation for the groups receiving 100 or 500 Ulml of heparin: 44 + 3 and 62 + 6 seconds (mean + standard error of the mean), respectively, in comparison to averages of 33 to 35 seconds at 24 hours in all groups and at 20 minutes after reflow in the control group. This study indicates that heparin added to the irrigation solution significantly enhances patency in compromised arterial anastomoses. The results also indicate a pitfall with studying topical heparin for microvascular surgery in rat models: acute elevation of activated partial thromboplastin time values.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The aim of this study was to examine the influence of membranous bone graft architecture on graft sunrival. Eighteen adult New Zealand rabbits underwent full-thickness hanresting of their zygoma, which was then divided into two parts, resulting in a wider, thicker anterior graft and a tapered posterior graft. The grafts were then rigidly fixed, one to each nasal bone, using titanium lag screws. On postgrafting days 15 and 45, 3 animals each were killed. The remaining 12 animals were killed on day 90. The graft, grafbhost interface, and contralateral zygoma were assessed volumetrically, histologically (nondecalcified), and stereologically. Volumetrically, the anterior (thicker, wider) grafts demonstrated 100% sunrival while the posterior (thinner, more narrow) grafts demonstrated 80% sunrival (p = 0.004). Histologically, the anterior grafts demonstrated less resorption and porosity and greater labeling activity. At the graft-host interface, the anterior grafts exhibited a 2.5-fold increase in full incorporation of the grafts, and the posterior grafts had almost twice the incidence of nonincorporation. Stereological measurements, including interlabel width (20.3 pm anteriorly, 18.9 pm posteriorly), confirmed the enhanced sunrival of the anterior grafts. Using multiple forms of analyses, this study demonstrates that membranous bone graft architecture influences graft sunrival. To assist in understanding these differences, we also analyzed the normal contralateral zygoma. While the anterior and posterior halves had a relatively constant amount of bicortical bone, the thicker grafts had a proportionally greater trabecular component (i.e., increased diploe-to-cortical ratio). In the rabbit model, differences in membranous bone thickness imply differences in the cancellous portion of the graft, thereby influencing ultimate graft sunrival.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Nasal gliomas are rare, benign, congenital masses more accurately referred to as sequestered glial tissue. Seven patients with nasal glioma treated by Hugh G. Thomson over the last 28 years are presented with special reference to tumor recurrence after excision and associated naso-ocular cleft. Three of our patients had an associated ipsilateral naso-ocular cleft, and three similar cases have been reported. This association is probably more frequent because a naso-ocular cleft can exist as a forme fruste and be easily overlooked. The first two tumors resected in our series recurred within 10 months; however, no recurrences were seen after a new treatment protocol was initiated in 1972. This consisted of total excision of the skin overlying the tumor if the skin adhered to the mass or if glial elements were seen within the dermis on frozen section. Deep resection margin was also assessed by frozen section of the nasal mucosa or fibrous stalk of the tumor. Accordingly, unnecessary intracranial procedures were avoided without increasing the risk of recurrence.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID