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At least 271 records · Page 15Linked to original sources
PubMed2004

Lipografting: autologous fat grafting for total facial rejuvenation.

Surgeons who perform facial rejuvenation procedures have long recognized the importance of volume enhancement. The primary manifestation of aging is loss of subcutaneous tissue, especially the atrophy of fat, which directly contributes to laxity of skin. Autologous fat transplantation has been attempted for over a century with varying degrees of success but more recent techniques have provided more predictable, reproducible, and even permanent results. Fat is an ideal tissue filler substance because it is living tissue and because it is from the patient's own body it is nonallergenic. My technique has evolved over an 11-year period in more than 1800 patients. The procedure can be performed alone as a total facial rejuvenation or in combination with facelift or other facial surgery. The technique requires minimally traumatic fat harvesting, fat preparation, and multilevel facial infiltration. Excess fat not used in the initial procedure is frozen and stored at -16 degrees C and can be used successfully for minor touch-up procedures. Preoperative evaluation of the patient and their understanding of the benefits and limitations of volume restoration surgery is imperative. Structural improvement to the main support areas of the face in the appropriate aesthetic proportions is of prime importance.

Adipose Tissue↗
PubMed1993

Surgery for tricuspid insufficiency: long-term follow-up after De Vega annuloplasty.

Between 1975 and 1991, 97 consecutive patients underwent De Vega tricuspid annuloplasty either isolated or in combination with mitral, aortic, or mitral and aortic valve procedures. Preoperatively 96.9% of the patients were in New York Heart Association functional class III or IV. Causes of tricuspid insufficiency were functional tricuspid ring dilatation and a combination of dilatation and different organic tricuspid valve lesions. There were 17 early deaths (17.5%), primarily due to cardiac failure, none was related to the tricuspid annuloplasty. 80 perioperative survivors have been followed up for a mean of 4.7 +/- 4.1 years with a total of 462 cumulative patient-years. Actuarial 5-, 10-, and 15-year survival rates, including early deaths, were 64% +/- 5%, 48 +/- 6%, and 26% +/- 10%. Recurrence of tricuspid regurgitation was rated as moderate in 15% and severe in 18.8%. Ten patients required reoperation (2.2%/patient-year), of whom 8 were associated with tricuspid regurgitation (1.7%/patient-year). Although in all patients but one the De Vega annuloplasty was intact, the tricuspid ring was dilated; 4 patients had additional tricuspid organic valve lesions. 6 of the 8 patients had concomitant mitral valve or mitral prosthesis dysfunction. 26 patients died late (5.6%/patient-year) due to chronic cardiac failure in 50% and after reoperation in 7% of the patients. 4 patients had implantation of a permanent pacemaker (0.9%/patient-year). 54 patients (67.5%) are still alive, with 43% having no and 17.5% having only mild residual tricuspid regurgitation. De Vega annuloplasty is indicated with tricuspid insufficiency due to functional ring dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Laceration of the vessels of the kidney hilus. A complication not previously described in halo extension treatment].

During the last years the halo traction proved to be an appropriate preoperative procedure to provide the spinal region with corrective forces, although several complications became known. As a complication unknown as yet a laceration of the renal hilus vessels is described, and the possible causes are discussed. Consequently, in case of abdominal symptoms and signs, a possible intraabdominal or retroperitoneal vascular lesion must be taken into consideration besides the well-known spinal-traction/spinal-cord-traction-syndrome.

Angiography↗
PubMed2000

Unplanned incomplete Mohs micrographic surgery.

BACKGROUND: Incomplete Mohs micrographic surgery (MMS) is the cessation of MMS while the tumor margins are known to be still positive. OBJECTIVE: Our purpose was to examine the factors behind unplanned incomplete MMS and to identify means of avoiding and managing this situation when it arises. METHODS: We performed a retrospective case review examining clinical presentations, histologic features, and management of incomplete MMS. RESULTS: Fifteen of 10,346 procedures (0.15%) were identified as incomplete MMS. Complete records were available in 14 cases. The age range was 30 to 90 years; the study comprised 10 men and 4 women. The tumors included 9 basal cell and 4 squamous cell carcinomas and 1 dermatofibrosarcoma protuberans. The sites involved were nose, medial canthus, ear, scalp, and lower eyelid. Twelve cases dealt with unresectable disease, whereas two patients were unable to tolerate further surgery. Of the unresectable cases, MMS was terminated because of ongoing multifocal positive skin margins, bony invasion, or extension of tumor to other locations. Surgical defects were repaired, whereas residual disease was managed with a variety of methods. CONCLUSION: Incomplete MMS is a rare problem of either unresectable disease or inability of the patient to tolerate the procedure. Preoperative planning may help to identify both subgroups of patients. A multispecialty approach to managing these cases is often necessary.

Adult↗
PubMed2001

Selective versus total drainage for biliary obstruction in the hepatic hilus: an experimental study.

BACKGROUND: Controversy exists as to whether selective biliary drainage (SBD) or total biliary drainage (TBD) is preferable as a preoperative procedure before extended hemihepatectomy for hilar cholangiocarcinoma, especially with regard to the functional reserve of the future remnant liver. METHODS: SBD or TBD was performed after 1 week of total biliary obstruction in rats. In SBD, the biliary trees of the left lobes (approximately 70% of the liver) were kept obstructed, whereas the right lobes were drained selectively. Mitochondrial function and microsomal cytochrome content were examined before and 1, 2, and 4 weeks after drainage. RESULTS: The right lobes weighed significantly more after SBD than after TBD. There were no significant differences in mitochondrial function between the two groups. The microsomal cytochrome content per milligram of microsomal protein significantly decreased 1 week after biliary obstruction and then recovered to a similar extent after SBD and TBD in the right lobes. However, the total microsomal cytochrome content (nanomoles per 100 g body weight) and the overall rate of mitochondrial adenosine triphosphate synthesis (mmoles per minute per 100 g of body weight) in the right lobes 4 weeks after SBD were significantly greater than those after TBD. CONCLUSIONS: SBD is superior to TBD with regard to the functional reserve of the future remnant liver.

Animals↗
PubMed2005

Postoperative blindness following orbital surgery.

OBJECTIVE: To determine the occurrence of blindness following orbital surgery. MATERIALS AND METHODS: A retrospective study on 1593 cases who had undergone an orbital surgical procedure. Preoperative clinical examinations and radiological features were collected and reviewed, as well as the data regarding the postoperative outcome. RESULTS: There were 7 cases of postoperative blindness (0.44%). DISCUSSION: This percentage of cases with an unexpected development of blindness after surgery may represent a reasonable estimate of the general risk of encountering this complication after an orbitotomy. Many books and papers on orbital surgery make the reader aware that vision can be threatened after surgery due to the high risk of damaging the optic nerve, either directly or as a result of iatrogenic vascular damage caused by the surgical maneuvers. However, the percentage of postoperative blindness has not yet been widely reported.

Adolescent↗
PubMed1989

The role of parathyroid ultrasonography in the management of primary hyperparathyroidism.

High-resolution, real-time sonography can be used to assess the size and location of the parathyroid glands. The authors review the types of information provided by sonography and outline the ways in which it contributes to the management of primary hyperparathyroidism. Sonography usually can differentiate parathyroid adenoma from hyperplasia. In milder cases, with less parathyroid enlargement, this differentiation is difficult but can be facilitated by determining three dimensions for each gland. Preoperative knowledge of the presumptive location of an adenoma is most useful when the strategy of unilateral neck exploration is to be used because it will allow the exploration always to begin on the correct side. Sonographic evidence of hyperplasia should trigger a preoperative search for multiple endocrine neoplasia and will alert the surgeon that a bilateral neck exploration and thymectomy will be needed. A more universal benefit is the ability to predict or exclude intrathyroidal and subcapsular parathyroid tumors, thus guiding the decision for thyroid versus thymic exploration in the event of a missing abnormal gland. Sonography often fails to visualize parathyroid tumors in an ectopic position away from the thyroid bed. Such tumors, however, may be anticipated when the sonogram shows only three enlarged glands in cases of hyperplasia, or only three glands of normal size in a patient with strong biochemical evidence of hyperparathyroidism. Because it is noninvasive and inexpensive and can provide a wealth of information, the authors have adopted sonography as a routine preoperative procedure for primary hyperparathyroidism.

Adenoma↗
PubMed1992

Abdominoplasty combined with other intraabdominal procedures.

One hundred three patients underwent abdominoplasty combined with other intraabdominal procedures including 67 tubal ligations, 34 total abdominal hysterectomies and 2 cholecystectomies, from January 1983 to July 1991. The patients were divided into two groups, those undergoing the standard or total abdominoplasty and those undergoing limited abdominoplasty with or without liposuction in delimited areas. In this series of 103 patients, we found only two minor complications and only three patients were transfused with autologous units of blood. When performed by well-schooled surgical teams, abdominoplasty may be combined with intraabdominal procedures with gratifying results.

Abdominal Muscles↗
PubMed1998

Long-term results of functional endoscopic sinus surgery.

Although much has been reported on the short-term outcomes of functional endoscopic sinus surgery (FESS), little has been reported with regard to its long-term impact on chronic sinusitis. The senior author (D.W.K.) previously reported detailed subjective and endoscopic follow-up on 120 patients at a mean of 18 months following surgery. This current study represents a long-term follow-up (average, 7.8 years) of 72 patients (60%) from the same cohort. Of patients responding to a question about overall symptoms, 98.4% (n = 66) reported improvement compared with before surgery. There was a trend toward continued subjective improvement in symptom scores with longer follow-up, but the changes did not reach statistical significance. Thirteen patients (18%) required subsequent surgical procedures. Preoperative stage, prior surgery, and other factors that might affect outcome were evaluated. The study demonstrates that excellent subjective results following FESS can be maintained in the long term with appropriate postoperative management. The study also validates the concept that patients in whom the cavity can be normalized following surgery are unlikely to require further surgery.

Anti-Bacterial Agents↗
PubMed1984

Shoulder reconstruction following disarticulation for ruptured mycotic aneurysm.

A method of wound management following shoulder disarticulation is described. In this report, the primary lesion is a mycotic aneurysm of the axillary artery. The pectoralis major muscular flap provides satisfactory coverage and maintains shoulder contour. It can be performed in a single procedure. Preoperative arteriography is important to determine the extent of arterial damage as well as the vascular anatomy of the proposed flap.

Adult↗
PubMed1992

Desmopressin decreases operative blood loss in spinal cord injury patients having flap reconstruction of pelvic pressure sores.

To test the effectiveness of desmopressin in decreasing operative blood loss in major flap reconstructions, 44 hemostatically normal patients with spinal cord injury and pelvic pressure sores participated in a randomized, prospective, double-blind clinical trial. Each patient received a single dose of desmopressin (0.3 micrograms/kg) or saline placebo intravenously at the initiation of a reconstructive surgical procedure. Preoperative and postoperative hemoglobin, hematocrit, von Willebrand factor, and factor VIII determinations and measurement of intraoperative blood loss and transfusions of packed red cells were recorded. Desmopressin-treated patients experienced a smaller decline in hemoglobin and hematocrit levels postoperatively. In those patients requiring major flap reconstructions, the use of desmopressin significantly decreased intraoperative blood loss and subsequent transfusion requirements. The levels of von Willebrand factor and factor VIII tended to be higher, although not significantly so, in subjects receiving desmopressin. No patient experienced an adverse reaction to the drug. We conclude that a single dose of desmopressin, given immediately preoperatively, is safe and effectively decreases blood loss and transfusion requirements in patients undergoing major flap reconstructive surgery.

Blood Coagulation↗
PubMed2002

Evaluation of the usefulness of percutaneous transhepatic portal catheterization for preoperatively diagnosing the localization of insulinomas.

INTRODUCTION: The precise intraoperative localization of insulinoma is essential for successful surgical management. AIMS: To assess the usefulness of measuring insulin levels by preoperative percutaneous transhepatic portal catheterization (PTPC) and intraoperative ultrasonography (US). METHODOLOGY: PTPC and other preoperative procedures (enhanced computed tomography [CT], arteriography, and US) were performed in eight patients with insulinoma based on our experience during the past 18 years. Intraoperative US was performed in six of the eight patients. RESULTS: PTPC was undertaken in all eight patients, and increased levels of insulin at the sites corresponding to tumors were observed in all patients. Intraoperative US was performed in six patients, which made it possible to detect insulinomas as hypoechoic masses in all of these patients. All tumors were found to exist as single entities. CONCLUSION: PTPC showed the highest diagnostic accuracy in detecting the number of and accurately localizing the tumors before surgery. Meanwhile, all findings from intraoperative US were identical to those of the resection samples, suggesting that this method is a highly reliable examination technique. We conclude that a combination of PTPC and intraoperative US may be essential for the successful surgical management of insulinomas.

Angiography↗
PubMed1998

Current concepts in the management of post-radical prostatectomy impotence.

Erectile dysfunction after radical retropubic prostatectomy has a multifactorial aetiology, including both neurogenic and vasculogenic factors. Postoperative potency is improved with preservation of the neurovascular bundles in a nerve-sparing procedure. Preoperative and intraoperative identification and preservation of accessory pudendal arteries may also improve postoperative potency rates. The early institution of treatment with intracavernous alprostadil appears to improve postoperative potency rates. Treatment with newer therapeutic agents, such as Sildenafil and Invicorp, are both efficacious and well tolerated.

Journal Article↗
PubMed1994

Surgical resection for small cell carcinoma of the lung: a retrospective study.

BACKGROUND: A retrospective review was undertaken of the survival of 21 patients with histologically proven small cell carcinoma of the lung resected between 1977 and 1991. METHODS: Twenty one patients (20 men) of median age 60 (range 44-73) years underwent surgical resection. Patients were subjected to standard clinical staging procedures. Preoperative diagnosis was small cell carcinoma of the lung in 13, non-small cell lung cancer in one, and uncertain in seven patients. Clinical staging was stage I disease in 11 and stage II in 10 patients. RESULTS: Resection included pneumonectomy in 12 cases, lobectomy in eight, and one wedge resection. Resection was complete in 16 patients. Postoperative histopathological examination confirmed small cell carcinoma of the lung in 19 specimens and mixed small cell and non-small cell carcinoma of the lung in two. Pathological staging was stage I in 11, stage II in three, and stage III in seven patients. The final pathological diagnosis of the resected specimens (n = 18) was atypical carcinoid in one, pure small cell carcinoma of the lung in 15, and mixed small cell and non-small cell carcinoma of the lung in two patients. Fourteen patients also received chemotherapy and 10 received prophylactic cranial irradiation postoperatively. Excluding the patient with a final diagnosis of atypical carcinoid, the median survival (n = 20) was 29 months (range two to 133+). Median survival for patients with pathological stage I and II disease (n = 13) was 40 months (range nine to 133+) and for patients with pathological stage III disease (n = 7) 20 months (range two to 116+). The median disease free survival was 23 months. Eleven patients relapsed between two and 101 months. There was no advantage for those patients who received postoperative chemotherapy. CONCLUSION: Curative resection offers the best chance for long term survival in patients with small cell carcinoma of the lung with very limited stage disease.

Adult↗
PubMed1990

Arteriovenous malformations of the brain: recent results of endovascular therapy.

Results of embolization and subsequent surgical resection were reviewed in 38 patients with arteriovenous malformations (AVMs) of the brain during the past 3 years. Advanced techniques were used for embolization, including real-time digital subtraction angiofluoroscopy; directable microcatheters; and a mixture of microfibrillar collagen, polyvinyl alcohol sponge microparticles, and ethanol, in addition to acrylic glue. Embolization caused a permanent deficit in four patients (10.5%) (quadrantanopia [n = 3], cerebellar ataxia [n = 1]). Thirty-two patients (84%) underwent surgery after embolization, and 28 (74%) were completely cured, as assessed with postsurgical angiography. Twenty-five patients (66%) had either no deficit or no change in deficit after treatment. Two patients had worsening of a previous deficit after postembolization resection, two patients had mild weakness not previously present, and five patients had visual field defects. One patient developed Gerstmann syndrome after resection, and one patient with ataxia after embolization also had ataxia after surgical resection. Two patients died of complications due to surgical resection. Most of the AVMs in this series were large and complex. Embolization used predominantly as a preoperative procedure enabled complete resection, as achieved in the majority of these cases.

Adolescent↗
PubMed1990

Aneurysm, arteriovenous malformation and arteriovenous fistula in posterior fossa compression syndrome.

To discuss the problem of neuroradiological preoperative procedures in patients with therapy-resistant facial pain, we present 3 case examples of vascular processes in the cerebellopontine angle (aneurysm, arteriovenous malformation, arteriovenous fistula). The microsurgical treatment in combination with artificial embolization is described. The vascular causes of microvascular compression at the root entry zone of the trigeminal nerve and malformations involving the nucleus caudalis are reviewed.

Aged↗
PubMedDate not supplied

Radionuclide angiography in juvenile angiofibroma of the nasopharynx.

Radionuclide angiography was performed by intravenous injection of 99mTc-pertechnetate and recorded by serial gamma camera scintiphotographs. Its usefulness as a prebiopsy or preoperative procedure is demonstrated by two case reports of angiofibroma of the nasopharynx and it was also found to be useful for radiation therapy follow-up assessment. Radionuclide angiography offers a convenient and safe method to assess the vascularity of a mass and by this technique the surgeon may be alerted to the possibility of severe postbiopsy hemorrhage and also the occasional dramatic complications of radiological carotid angiography can be avoided.

Adolescent↗