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At least 631 records · Page 35Linked to original sources
PubMed1998

Laser blepharoplasty and laser resurfacing of the periorbital area.

Although blepharoplasty has long been the traditional method of improving the aesthetic appearance of the eyelid area, it yields little improvement in several of the major signs of periorbital aging including (1) wrinkling of the infrabrow and lower lid skin, (2) crow's foot wrinkles, (3) malar bags and wrinkles, (4) crepey changes in the periorbital skin texture, (5) pigment spots and other actinic damage, (6) elongation of the apparent vertical height of the lower lid, and (7) loss of the gentle, indistinct transition between the lower lid and cheek skin. All of these indications can be improved by the combination of laser blepharoplasty and laser resurfacing of the periorbital region. In addition to resurfacing, the author prefers to use the laser for the incisional aspects of the blepharoplasty, as it is quick, causes less sensory nerve stimulation, is less likely to damage the inferior oblique muscle, and has essentially no bleeding--and therefore, less ecchymosis--postoperatively. This technique is described and illustrated photographically. Its outcomes include a high-quality result that maintains itself well over time, improvement in the signs of periorbital aging not treated by traditional blepharoplasty, a low rate of complication, and high patient satisfaction.

Blepharoplasty↗
PubMed1998

Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties.

A prospective study of 69 patients (138 knees) who had a primary simultaneous bilateral total knee replacement was conducted to assess the effect of postoperative suction drainage on wound healing and infection. A suction drain was placed by randomization of side for the drained versus nondrained side. The same operative technique was used in all wounds of total knee arthroplasty. The knees that had no drains had a higher incidence of drainage from the wound, had soaked dressings requiring dressing reinforcements, and had more ecchymosis and erythema around the wound. However, the final results regarding quadriceps strength, range of motion, and wound complications were not affected significantly by nonuse of closed suction drainage. Although the incidence of infection in the two groups is not statistically different, the development of infection in two knees in which drains were not used suggests that suction drainage may reduce deep infection.

Adult↗
PubMedDate not supplied

[Technique of repair of acquired inguinal hernia by anterior reinforcement of the Fruchaud floor with polypropylene mesh].

The main cause of acquired inguinal hernia is weakness of Fruchaud's deep muscolofascial floor, following metabolically-determined collagen disorders. A technique for the anterior reinforcement of this structure with polypropylene mesh is described here. Following intermuscular decollement, the mesh is placed in direct contact with the surface formed by the transversalis fascia and the transversus abdominis muscle and stretched as extensively as possible. Because the posterior aspect of the inguinal canal is the true barrier to abdominal pressure, the author believe that its direct reinforcement, without interposition of the internal oblique muscle, constitutes the most correct anatomo-surgical approach to hernia repair. This is the case for both indirect hernias, in which the internal ring is reconstructed at a deeper level, and for direct hernias, in which the "tent effect" of the prosthesis is prevented. Ninety-two primary inguinal hernias (56 indirect, 29 direct and 7 direct and indirect) in 87 patients were repaired with this technique. Seventy-nine patients were followed up from 2 to 24 months. Early complications included: 7 ecchymosis, 3 seromas, 2 subcutaneous infections, 3 testicular swellings. Incision and testicular pain for longer than 6 months occurred in 2 cases. No prosthetic infections or recurrences have been detected up to the present.

Adult↗
PubMed1998

Skin tears in institutionalized elderly: an epidemiological study.

Skin tears in the elderly are a common alteration of aging skin integrity. Very little is found in the literature on the prevention, identification, and treatment of skin tears. During a six-month period, 154 skin tears were studied in a convenience sample of residents in a VA Nursing Home Care Unit and nine community nursing homes. Data were collected on demographics, medication use, laboratory tests, cognitive function, and activities of daily living (ADLs). Descriptive data on the skin tears were also collected and these tears were graded according to the Payne-Martin Classification System. Data analysis revealed an at-risk sample of very old, frail elderly who are predominantly women, dependent in ADLs, nutritionally compromised, and suffering from dementia. Risk factors associated with the occurrence of skin tears included stiffness and spasticity, sensory loss, limited mobility, poor appetite, polypharmacy, use of an assistive device, presence of ecchymosis, and a history of previous skin tears. Skin tears were small, occurred more frequently on the upper extremities, and half had no tissue loss. Most skin tears occurred in patient care bedrooms. The findings of this study provide an outline for the development of an at-risk profile, and establish the basis for educational programs for caregivers.

Adult↗
PubMed1998

Stereotactic breast biopsy: indications and results.

Imaging-guided breast biopsy performed with large-core needles can accurately diagnose most breast pathologies, often allowing a diagnosis to be made more quickly and less expensively than with surgical biopsy. Major complications, such as hemorrhage and infection, are extremely rare, although post-biopsy ecchymosis and tenderness are not unusual. Because less tissue is removed, post-biopsy cosmetic deformity does not occur. Stereotactic biopsy is performed by triangulating the position of a breast lesion and by obtaining views angled equally off a central axis. This can be done using dedicated tables or add-on equipment. Stereotactic core biopsy has a reported accuracy of at least 90%. All lesions for which biopsy would ordinarily be recommended are amenable to stereotactic techniques, but those near the chest wall or in the axilla may be more difficult to biopsy with some equipment. Lesions characterized by calcifications are sometimes more difficult to sample. A biopsy diagnosis of ductal atypia, because of its histologic heterogeneity, requires surgical excision to exclude coexistent carcinoma, which has been found in half of women at subsequent surgical excision. A core biopsy diagnosis of ductal carcinoma in situ does not preclude the discovery of invasive carcinoma at surgery. In rare instances, the small tissue volume removed at stereotactic biopsy does not permit a final diagnosis to be made; this occurs most commonly when differentiating phyllodes tumor from fibroadenoma.

Biopsy, Needle↗
PubMed1997

[Hematoma of the iliac psoas muscle. 29 cases].

We present 29 cases of haematoma of the iliac psoas muscle, following anticoagulant treatment and review 158 cases so far published. In 60 p. 100 of cases, the anticoagulant was some form of intravenous or subcutaneous heparin; prescribed in 40 p. 100 of cases for venous thrombosis followed rapidly by pulmonary embolism, in half the cases between the 3rd and the 14th day. Hypocoagulation was excessive in 64 p. 100 of the cases. Clinically the onset is marked in all cases by a violent pain in the territory of femoral nerve, anaemia (40 p. 100) psoïtis (32 p. 100) and iliac mass (51 p. 100), ecchymosis (13 p. 100) and particularly 23 among 29 cases an early or late femoral paralysis. The clinical diagnosis has been confirmed by echography 21 cases an or CT scan (7 cases). Our approach has been definitely surgical. The surgical procedure carried out in 20 p. 100 of the cases published, and in 23 of our ones, relieves the pain, provides for an early efficient physiotherapy, and a regression of the femoral paralysis, much more rapidly and completely than in the absence of surgery. The anatomical lesions, and the condition of the femoral nerve are described in the operative records, account for that evolution and explain our position. Traumatic and hemophilic have evocated.

Adult↗
PubMedDate not supplied

[Spontaneous rupture of hydrocele: an unusual complication].

Description of a case report of a male patient with a long standing pressure hydrocele that underwent spontaneous rupture while doing farm work although there was no previous trauma. The clinical signs were minimal scrotal discomfort, disappearance of turgescence and late ecchymosis and localized edema in penis and scrotum.

Humans↗
PubMed1998

Video-assisted endoscopic saphenous vein harvesting for coronary artery bypass grafting.

Saphenous vein grafts for coronary artery bypass can be harvested by means of the traditional long incision method, the skin bridge method, or a newly developed endoscopic technique. We applied the endoscopic technique to reduce the length of leg incision and to decrease the frequency of complications. Between September and December 1996, 47 patients underwent coronary artery bypass grafts, 17 of whom volunteered to undergo saphenous vein harvest with the Endopath video-assisted endoscopic saphenous vein harvest (ESVH) system; the other 30 patients underwent the traditional long incision harvest procedure. A total of 22 saphenous veins were harvested from the 17 patients who underwent ESVH. The mean length of the leg wound was 5.8 +/- 1.3 cm and the mean length of the vein harvested was 32.9 +/- 3.4 cm (wound/vein length ratio 17.6%). The wound/vein length ratio of the 30 patients who underwent the traditional open harvest method was 91.5% (30.8 +/- 2.2 cm/34.1 +/- 3.0 cm). ESVH failed and was converted to the conventional method in two cases. The mean time required to harvest the saphenous vein was 72.7 +/- 20.8 minutes in the ESVH group and 45.8 +/- 12.5 minutes in the open surgery group. No wound complications were noted in the ESVH group, except for ecchymosis in three cases. Five patients in the open surgery group had wound discharge (17%). The length of hospital stay was shorter (10.5 +/- 2.6 days vs 15.8 +/- 4.2 days) and fewer analgesics were used in the ESVH group. The rate of cardiac complications was not different between the two groups. Examination of the vein graft under light microscopy also did not reveal any differences. We conclude that the endoscopic technique can provide adequate vein grafts for use in coronary artery bypass grafting and reduce the leg wound complication rate, hospital stay, and use of analgesics.

Aged↗
PubMed1999

Enterocutaneous fistula as a postoperative complication of laparoscopic inguinal hernia repair.

Trocar injuries to the small bowel during laparoscopic hernia repair are a rare complication, the most common complications being postoperative neuralgias, scrotal swelling, scrotal ecchymosis, and hematoma. A 15-year-old boy was admitted 5 days status-post transabdominal laparoscopic inguinal hernia repair of a symptomatic right pantaloon hernia, with signs and symptoms of a retrocecal abscess. Despite laparotic intervention and appendectomy, the next 2 years passed with almost daily, purulent, right lower quadrant wound drainage, in an otherwise asymptomatic patient. Superficial wound exploration and sinogram in 1996 revealed a sinus tract in direct communication with the small bowel. Elective laparotomy in December 1997 involved a successful resection of a 2.5-cm fistula with involved mesh, and the communicating small bowel through a midline incision, followed by a primary closure of the small-bowel opening. The patient has recovered without complications.

Adolescent↗
PubMed1999

Low-molecular-weight heparin: an antithrombotic agent whose time has come.

LMWH (enoxaparin) should be used in combination with aspirin in the early phase of non-Q wave MI and in patients with unstable angina. The benefit of LMWH in acute coronary syndromes has been validated in several clinical trials. In addition, the use of LMWH is cost-effective when compared with use of UFH. The incidence of minor bleeding may be greater with LMWH than with UFH, most frequently due to ecchymosis at the injection site. However, the frequency of major bleeding did not differ between the two heparins. LMWH has been used successfully for the past 4 years by orthopedic surgeons in the prevention of pulmonary emboli. LMWH should replace UFH in the management of acute coronary syndromes.

Angina, Unstable↗