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Purpose: Ultrasound-guided manual vacuum aspiration (USG-MVA) is a feasible and effective outpatient treatment to treat early pregnancy loss. Methods: This was a prospective observational study at a university-affiliated hospital. All women undergoing either a USG-MVA or electric vacuum aspiration (EVA) were invited to return 3–6 months later for follow-up at which women completed a questionnaire to document their post-evacuation menstrual and reproductive history, and underwent a hysteroscopy if they were not pregnant. The severity of intrauterine adhesion (IUA), if present, was graded (Stage I-III) according to the American fertility society classification. Results: A total of 292 women had a hysteroscopy after their initial surgical evacuation, USG-MVA 169(57.9%) versus EVA 123(42.1%). Women undergoing EVA as opposed to a USG-MVA had a 12.9% higher incidence of IUA (24.1% vs. 37.0%, p = 0.042) equivalent to 1.84 times higher risk (95% CI 1.01–3.34; p = 0.048). Women having EVA continued to show an increased but not statistically significant trend towards an increased risk of IUA after adjusting for the type of miscarriage (aOR = 1.3; 95% CI 0.66–2.50; p = 0.46). Conclusion: There were no significant differences in their reproductive outcomes and fewer women post-USG-MVA complained of hypomenorrhea. IUA may still occur in women undergoing USG-MVA but it is lower than the rate in women undergoing EVA. Clinical trials registry The trial was registered with the Centre for Clinical Research and Biostatistics – Clinical Trials Registry (CCRBCTR), a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) with a Unique Trial Number: CUHK_CCRB00541 on 22 Dec 2016. [ABSTRACT FROM AUTHOR]

Background: Plastic surgery patients frequently request extensive liposuction on approximately 30 % of the total body surface area, which indicates that the total dose of lidocaine used might exceed the recommended level. Our previous study demonstrated that the risk of toxicity is low because the peak lidocaine level is below the toxic threshold (3 μg/mL). However, monoethylglycinexylidide (MEGX), the active metabolite of lidocaine, has not been measured in extensive liposuction operations. Methods: Ten female patients who requested extensive liposuction were enrolled in this study. The targeted areas were divided into two segments and treated in turn for one session. Serum levels of lidocaine and MEGX were taken every 4 h during the first 24 h after the second infiltration. Results: The peak lidocaine levels (1.94 ± 0.4 μg/mL) were observed after 12-20 h (16.8 ± 2.53 h), whereas the peak MEGX levels (0.67 ± 0.12 μg/mL) were observed after 16-20 h (17.6 ± 2.07 h). The peak concentrations of lidocaine plus MEGX (2.58 ± 0.47 μg/mL) were observed after 17.2 ± 2.4 h. Conclusions: This study demonstrated that the risk of MEGX toxicity was as low as that of lidocaine toxicity in extensive liposuction operations. Level of Evidence: Level IV, risk / prognostic study. [ABSTRACT FROM AUTHOR]

Purpose: To present the outcomes of four cases of cesarean scar pregnancy treated with suction curettage. Methods: Four patients were ultrasonographically diagnosed with cesarean scar pregnancies treated with suction curettage in a tertiary care center. Results: Serum β-human chorionic gonadotropin levels ranged between 1,681 and 15,573 mU/mL, gestational sac diameter measured from 10 to 24 mm and scar thickness was between 4.7 and 6.8 mm. All patients underwent suction curettage under general anesthesia with transabdominal ultrasonography guidance. No complications were observed during or after operation. Conclusion: Suction curettage is a viable alternative for conservative treatment in selected cases of patients who are diagnosed with CSP early in gestation and who have a myometrial thickness of more than 4.5 mm. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the efficacy and safety of the medical method in the management of first trimester spontaneous onset incomplete abortion, by using misoprostol vaginal tablets, in comparison to surgical evacuation, with an intention of completing the procedure within 24 h. Methods: In this prospective, randomised study of 100 women admitted with features suggestive of incomplete abortion, 50 women received misoprostol vaginal tablets, while another 50 underwent suction curettage of products of conceptus. They were followed up after 24 h of last dosage of misoprostol or surgical intervention. Statistical analysis was done with respect to efficacy, safety and procedure-related side effects. Results: In this study, when analysed after 24 h of treatment allocation, the efficacy of misoprostol was 91.3 %, and the efficacy of the surgical method was 96 %, with the statistical difference being insignificant. Procedure-related blood loss and pain perception between the two groups were statistically insignificant. However, the incidence of fever in the misoprostol group statistically appeared higher. Conclusions: Misoprostol could be a safe and easily accessible alternative to surgical evacuation, in cases of first trimester spontaneous onset incomplete miscarriage, and could be administered by the patient herself at home. [ABSTRACT FROM AUTHOR]

The article describes a study which established a safe volume limit for aspirate under wet liposuction in relation to body weight. The study included 30 patients who underwent wet liposuction and a 24-hour noninvasive postoperative monitoring control of vital signs. The patients' hemogloobin, leukocyte counts and hematocrit were also analyzed. Study authors concluded that the safe volume of aspiration for wet liposuction should not be more than five percent of body weight.

Enchondroma of a hand is a common benign tumor. Enchondroma commonly presents as a pathological fracture associated with pain, deformity, and swelling. Dysfunction of the fingers occurs as a result of the fracture. Curettage is the mainstay of surgical treatment for enchondroma. [ABSTRACT FROM AUTHOR]

Abstract  Data on preparation of chitin threads for the fabrication of absorbable suture materials, dressings, and biodegradable substrates for the growth of human skin cells (keratinocytes and fibroblasts) are analyzed. [ABSTRACT FROM AUTHOR]

Background: The distal end of the radius is one of the common sites of involvement in giant cell tumors (GCTs) with reportedly increased propensity of recurrence. The objective of the present analysis was to study the modalities of management of the different types of distal end radius GCTs so as to minimize the recurrence rates and retain adequate function. Materials and methods: Twenty-four patients of distal end radius GCTs treated between January 2000 and December 2004 were retrospectively reviewed. Nineteen cases were available for follow-up with an average follow-up of 37.5 months. There was one Campanacci Grade 1 lesion, nine Grade 2 and 14 Grade 3 lesions. Thirteen (54%) of these patients were treated elsewhere earlier and presented with recurrence. The operative procedures that were performed were: curettage and cementing (five), curettage and bone grafting (seven), excision and proximal fibular arthroplasty (two), excision and wrist arthrodesis (nine) and excision of soft tissue recurrence (one). Results: Functional status was evaluated using Musculo Skeletal Tumor Society scoring system which averaged 78%. The recurrence rate was 32%. Complications included local recurrence (six), nonunion at the graft bone junction (one), infection (one), deformity (two), stiffness (two), subluxation (two) and bony metastasis (one). Conclusions: The majority of patients undergoing curettage were either Campanacci Grade 1 or 2. Patients undergoing curettage and reconstruction had a better functional result (82%) as compared to arthrodesis or fibular arthroplasty (69%). Previous intervention did not appear to increase the recurrence rates. Even though complications occur, judicious decision-making and an appropriate treatment plan can ensure a satisfactory outcome in the majority of cases. [ABSTRACT FROM AUTHOR]

Giant cell tumor (GCT) of bone though one of the commonest bone tumors encountered by an orthopedic surgeon continues to intrigue treating surgeons. Usually benign, they are locally aggressive and may occasionally undergo malignant transformation. The surgeon needs to strike a balance during treatment between reducing the incidence of local recurrence while preserving maximal function. Differing opinions pertaining to the use of adjuvants for extension of curettage, the relative role of bone graft or cement to pack the defect and the management of recurrent lesions are some of the issues that offer topics for eternal debate. Current literature suggests that intralesional curettage strikes the best balance between controlling disease and preserving optimum function in the majority of the cases though there may be occasions where the extent of the disease mandates resection to ensure adequate disease clearance. An accompanying treatment algorithm helps outline the management strategy in GCT. [ABSTRACT FROM AUTHOR]

Background: Giant cell tumors (GCT) are neoplasms of mesenchymal stromal cells with varied manifestations. There is no uniform accepted treatment protocol for these tumors, Materials and Methods: 49 cases of proven giant cell tumors of appendicular skeleton, 27 prospective and 22 retrospective constituteed this study. The retrospective cases were collected by using computerized data base collection method. The patients were evaluated clinically, radiologically and by histology. Companacci grading and Enneking staging was used in the study. Two treatment modalities were used a) extended curettage (with/ without bone grafting/ cementation) or b) wide excision and reconstruction with a prosthesis or arthrodesis. Functional evaluation was done by Enneking's system. Chi square tests, mannwhitney test and ANOVA were used for statistical analysis. Results: The average age was 26.82 years (16-50 years). 25 patients (51%) were recurrent GCT at presentation. The commonest site was lower end of femur (16 cases, 32.65%) and upper end of tibia (13 cases, 26.53%). 40 (81.63%) tumors had less than 5 mm of subchondral bone free of tumor. 35 (71.43%) tumors were Enneking's surgical stage III and companacci grade III. Pathological fractures were seen in 12 (24.49%) cases. Intra-lesional currettage was used in 28 and enbloc excision in 19 patients and 2 (4.08%) underwent amputation. The average follow up period was 18.6 months (range 2-84). One recurrence was seen in a grade III recurrent distal radial lesion in the intralesional curettage group (3.57%) Enneking's functional score with intralesional curettage (25.41) was better than enbloc excision (21.37). Enbloc excision had higher rates of infections (36.84 % Vs 25%) and soft tissue coverage problems (21.05% Vs 0). Conclusion: Intralesional therapy has a better functional outcome and less complications than enbloc excision, albeit with a high recurrence rate which can however be effectively treated with repeat extended curettage. [ABSTRACT FROM AUTHOR]

Background:The clinical behavior and treatment of giant cell tumor of bone is still perplexing. The aim of this study is to clarify the clinico-pathological correlation of tumor and its relevance in treatment and prognosis. Materials and Methods: Ninety -three cases of giant cell tumor were treated during 1980-1990 by different methods. The age of the patients varied from 18-58 yrs with male and female ratio as 5:4. The upper end of the tibia was most commonly involved (n=31), followed by the lower end of the femur(n=21), distal end of radius(n=14),upper end of fibula (n=9),proximal end of femur(n=5), upper end of the humerus(n=3), iliac bone(n=2),phalanx (n=2) and spine(n=1). The tumors were also encountered on uncommon sites like metacarpals (n=4) and metatarsal(n=1). Fifty four cases were treated by curettage and bone grafting. Wide excision and reconstruction was performed in twenty two cases . Nine cases were treated by wide excision while primary amputation was performed in four cases. One case required only curettage. Three inaccessible lesions of ilium and spine were treated by radiotherapy. Results: 19 of 54 treated by curettage and bone grafting showed a recurrence. The repeat curettage and bone grafting was performed in 18 cases while amputation was done in one. One each out of the cases treated by wide excision and reconstruction and wide excision alone recurred. In this study we observed that though curettage and bone grafting is still the most commonly adopted treatment, wide excision of tumor with reconstruction has shown lesser recurrence. Conclusion: For radiologically well-contained and histologically typical tumor, curettage and autogenous bone grafting is the treatment of choice. The typical tumors with radiologically deficient cortex, clinically aggressive tumors and tumors with histological Grade III should be treated by wide excision and reconstruction. [ABSTRACT FROM AUTHOR]

Objective: To assess lung volume and compliance changes during open- and closed-system suctioning using electric impedance tomography (EIT) during volume- or pressure-controlled ventilation.Design and Setting: Experimental study in a university research laboratory.Subjects: Nine bronchoalveolar saline-lavaged pigs.Interventions: Open and closed suctioning using a 14-F catheter in volume- or pressure-controlled ventilation at tidal volume 10 ml/kg, respiratory rate 20 breaths/min, and positive end-expiratory pressure 10 cmH2O.Measurements and Results: Lung volume was monitored by EIT and a modified N2 washout/-in technique. Airway pressure was measured via a pressure line in the endotracheal tube. In four ventral-to-dorsal regions of interest regional ventilation and compliance were calculated at baseline and 30 s and 1, 2, and 10 min after suctioning. Blood gases were followed. At disconnection functional residual capacity (FRC) decreased by 58+/-24% of baseline and by a further 22+/-10% during open suctioning. Arterial oxygen tension decreased to 59+/-14% of baseline value 1 min after open suctioning. Regional compliance deteriorated most in the dorsal parts of the lung. Restitution of lung volume and compliance was significantly slower during pressure-controlled than volume-controlled ventilation.Conclusions: EIT can be used to monitor rapid lung volume changes. The two dorsal regions of the lavaged lungs are most affected by disconnection and suctioning with marked decreases in compliance. Volume-controlled ventilation can be used to rapidly restitute lung aeration and oxygenation after lung collapse induced by open suctioning. [ABSTRACT FROM AUTHOR]

Background: This article introduces a new technique for hepatectomy. Its purpose is to describe the details of laparoscopic hepatectomy by curettage and aspiration (LHCA) and develop a new instrument for this technique.Methods: We have performed laparoscopic hepatectomy by curettage and aspiration (LHCA) in 62 patients in our institute between 1998 and 2005: 34 men and 28 women, mean age 47.8 years (range: 26-71 years). Their diagnoses included 18 primary hepatic carcinoma, 2 metastatic carcinoma, 19 intrahepatic duct calculus, and 23 benign entities.Results: The LHCA operation was completed in 60 patients. In two, the procedure had to be converted to open operation. The mean operative time was 146 min and the mean operative blood loss was 458 ml. Complications occurred in two patients, one with bile leakage and the other with pneumothorax. All the patients were ambulatory within 24 hours of operation. The average length of hospital stay was 1 week.Conclusions: Our experience leads us to believe that laparoscopic hepatectomy by curettage and aspiration (LHCA) is a safe and effective technique for resection of liver lesions. [ABSTRACT FROM AUTHOR]

A novel method for plication of the abdominal fascia in miniabdominoplasty addresses abdominal laxity and improves the waistline. The design comprises a vertical plication of the rectus fascia from xiphoid to pubis and fusiform plication of the oblique fascias with limited undermining and scars, all in the setting of a miniabdominoplasty. The procedure was performed for 10 women undergoing surgery between January and December 2004. The technique resulted in improved tension of the entire abdomen, a decreased perimeter of the waist, and improved uniformity in the contour of the anterior and lateral view, avoiding the epigastric bulking generated when infraumbilical vertical plication is used alone. There were few minor and no major complications. At the follow-up assessment 6 months to 2 years after surgery, there was no loss of the improved muscle–aponeurotic tension or abdominal contour. Triple plication of the fascia provides a good method for improving both the waistline and abdominal laxity in the setting of a miniabdominoplasty. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is technically challenging. We describe our technique and present our experience with a transperitoneal hand-assisted laparoscopic (HAL) technique using a standard vacuum curettage system to reduce the size of the kidneys thereby facilitating nephrectomy.Materials and Methods: A retrospective review was completed of 10 consecutive patients undergoing bilateral HAL nephrectomy between March 2002 and October 2004 using the following technique. A hand port is positioned through a 6-7 cm periumbilical incision and port sites are placed at the midclavicular line (12 mm) and anterior axillary line (5 mm) on the side of the initial nephrectomy. After the renal vessels are divided and the kidney is completely mobilized a 12 mm curette is inserted through the medial port site. The Berkeley VC-10 Vacuum Curettage System (ACMI, Southborough, MA) is used to morcellate and aspirate the kidney providing a significant decrease in the overall size and allowing easy extraction through the midline incision. The procedure is repeated for the contralateral side.Results: All 10 patients underwent successful bilateral HAL nephrectomy with a mean operative time of 194 minutes. The average length of stay was 4.7 days. Patients with renal allografts had stable function at the time of discharge. The average size of the kidneys removed was 717 g and average length was 19 cm. All patients did well postoperatively with complete resolution of their presenting symptoms.Conclusion: In patients with symptomatic ADPKD, bilateral HAL nephrectomy using the vacuum curettage system to minimize the size of the kidneys is fast, safe and effective. [ABSTRACT FROM AUTHOR]

Background: A number of plastic surgeons have advocated using hypotonic solution in ultrasound lipoplasty, theorizing that induced adipocyte swelling increases membrane susceptibility to ultrasonic disruption. Additionally, it has been theorized that potassium increases membrane permeability. This study aimed to determine the effect of solution osmolality on adipocyte diameter, the time course of hypotonic solution action, and the effect of potassium addition on adipocyte diameter. Methods: Base solutions with three different osmolalities were prepared: normal saline (NS) (154 mOsm/l), ½NS (77 mOsm/l), and ¼NS (38.5 mOsm/l). Each solution was modified to contain 0, 5, and 10 mEq/l of potassium and adjusted to starting osmolality. Adipocytes of six patients were suspended in the nine solutions, and diameters were determined at 0, 15, 30, and 45 min. Diameters were measured using imaging software (Kodak ID 3.6). Results: At time 0, the average adipocyte diameter was 79 ± 8 lm, and no difference was seen in any of the solutions. Cells in the NS group showed no significant increase in diameter over 45 min. The ½NS group achieved an 8% ± 1.9% increase in diameter at 45 min (p < 0.05). The ¼NS group showed an increase by 14% ± 2.4% (p < 0.01) at 15 min, and 15% ± 2.3% (p < 0.01) at 45 min. Potassium had no independent effect on cell diameter. Conclusions: Hypotonic solution can significantly increase human adipocyte diameter. The findings showed that ½NS had a significant effect within 15 min. Tumescent solutions with an osmolality of ¼NS may be useful in facilitating ultrasonic lipoplasty. [ABSTRACT FROM AUTHOR]

Power-Assisted lipoplasty (PAL) is a new method introduced to simplify and standardize surgical results of traditional suction-assisted lipoplasty (SAL). Comparative studies already have demonstrated PAL to be a handy, atraumatic, time- and fatigue-sparing technique. The authors performed a pilot study to compare the output capacity of PAL and SAL in 15 healthy female patients. The general and the specific per area outputs over 1 min from symmetrical areas were assessed. The results confirmed the efficiency of PAL (17.41% increase in average specific area output, as compared to SAL) and the distribution of fat in major “fat storage” areas such as the abdomen and the anterior thigh. Specific per area output indicated a higher suction capacity for PAL in all areas except the inner thigh. The efficiency of PAL seemed to be less influenced than that SAL by fat distribution. [ABSTRACT FROM AUTHOR]

Background: Breast reduction surgery is known to be more effective than medications, diet, or support bras in relieving the suffering from excessively large breasts. Liposuction- only breast reduction, without surgery, is effective for eliminating symptoms and significantly reduces scarring and complications. The procedure allows women to maintain nipple sensation and the ability to breast-feed. The author describes his technique, results, and new observations over a 2-year period. Methods: The results from the charts and photos of all patients in the study group were retrospectively reviewed. Results: The patients were very satisfied with the results of their treatment. New observations are detailed. Complications were minimal. No cases of increased ptosis resulted from suction. Conclusions: Breast liposuction is an excellent technique that reduces scars, complications, recovery, and costs. It is a technique that should be readily available to women in every society. [ABSTRACT FROM AUTHOR]

Background: As a reaction to reported adverse outcomes after lidocaine infiltration in tumescent liposuction, prilocaine has gained increasing popularity. Previous studies investigating large-volume liposuction procedures found maximum prilocaine levels and Methemoglobinemia up to 12 h postoperatively, suggesting that liposuction should be performed as a hospital procedure only. The aim of this study was to determine prilocaine plasma levels and methemoglobinemia in patients after low- to average-volume liposuction for the purpose of defining the required post-operative surveillance period. Methods: In 25 patients undergoing liposuction involving less than 2,000 ml prilocaine levels and methemoglobinemia were measured over 4 h postoperatively. Liposuction was conducted after the tumescent technique using a 0.05% hypotonic prilocaine solution with epinephrine. Results: The average prilocaine dose was 6.8 + 0.8 mg/kg, with a maximum dose of 15 mg/kg. The peak prilocaine plasma level of 0.34 μg/ml occurred 3 h after the infiltration. The mean methemoglobinemia at this time point was 0.65%. Only one patient demonstrated a slightly elevated methemoglobin level of 1.4%, but lacked any clinical signs of methemoglobinemia. The prilocaine recovery in the aspirate averaged 36 ± 4%, indicating that a large amount is removed by suctioning. Conclusions: The patients did not experience high plasma levels of prilocaine or methemoglobinemia undergoing liposuction involving less than 2.000 ml using a 0.05% hypotonic prilocaine solution. The authors therefore conclude that this procedure can be performed safely with a monitoring period of 12 h. [ABSTRACT FROM AUTHOR]

Background. Simple curettage without bone grafting for enchondromas of the hand and its good clinical results have been reported. Yet, there have been no reports regarding simple curettage without bone grafting for enchondromas of the foot. The purpose of this study is to elucidate the clinical results of this method for enchondromas of the foot. Methods. We studied eight patients (ten bones) with enchondromas of the foot treated with simple curettage without bone grafting. After making an oval or round fenestration, the enchondroma was curetted. The cortical window of the fenestration was excised in five bones, whereas it was replaced at the fenestration site in the other five bones. Results. The affected toe was immobilized with a tape in two patients. All patients began to walk on the day of surgery or the next day without crutches. Sclerotic changes on the plain radiographs were seen 6.4 weeks (range: 4–10 weeks) postoperatively. The patients returned to their normal daily activity including occupation and sport in 8.6 weeks (range: 0–12 weeks) postoperatively. The radiographic appearance was almost normalized in 8.4 months on average (range: 3–14 months). Function was classified as excellent in all bones according to a modified Tordai classification. Conclusion. We conclude that simple curettage without bone grafting can be one of the standard surgical treatments for enchondromas of the foot. [ABSTRACT FROM AUTHOR]

We evaluated the possibility of discovering bleeding causes in late postmenopausal period with cytological examination of material received by endometrial brush in comparison with Pap test and fractionated curettage. Sixty-two women in late postmenopausal period with cervical canal bleeding, treated in gynecological department of clinical hospital in Osijek, were cytological and histological processed. Final diagnosis in 29 from 62 (46.8%) women with late postmenopausal bleeding was cancer. 25 (40.3%) women had endometrial adenocarcinoma and 4 (6.5%) of them had squamous endocervical carcinoma. Two women had endometrial precancerous (3.2%). With Pap test accurate diagnosis was set up in 13 from 25 (52.0%) women with endometrial adenocarcinoma and in all of them with squamous endocervical carcinoma. With endometrial brush accurate diagnosis was set up in 14 from 25 (56.0%) women with endometrial adenocarcinoma and in 3 from 4 (75.0%) women with squamous endocervical carcinoma. With fractional curettage the diagnosis of endometrial adenocarcinoma was accurately correct in 21 from 25 (84.0%) women and in all of them with squamous endocervical carcinoma. Cytological examination of material derived with endometrial brush, alike vaginal cytology, is not enough reliable method in our conditions for discovering bleeding causes in late postmenopausal period. Diagnostic exactness of procedure could be increased by histopathological examination of material from endometrial brush procedure and with ultrasound evaluation of endometrium thickness. [ABSTRACT FROM AUTHOR]

Study objective.. Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in duration of intubation, length of stay in the ICU, and ICU mortality. Design.. Randomised prospective clinical trial. Setting.. In two ICUs at University Hospital Groningen, the Netherlands. Patients.. Three hundred and eighty-three patients requiring endotracheal intubation for more than 24 h. Interventions.. Routine endotracheal suctioning (n=197) using a 49-cm suction catheter was compared with on-demand minimally invasive airway suctioning (n=186) using a suction catheter only 29 cm long. Measurements and results.. No differences were found between the routine endotracheal suctioning group and the minimally invasive airway suctioning group in duration of intubation [median (range) 4 (1–75) versus 5 (1–101) days], ICU-stay [median (range) 8 (1–133) versus 7 (1–221) days], ICU mortality (15% versus 17%), and incidence of pulmonary infections (14% versus13%). Suction-related adverse events occurred more frequently with RES interventions than with MIAS interventions; decreased saturation: 2.7% versus 2.0% (P=0.010); increased systolic blood pressure 24.5% versus 16.8% (P<0.001); increased pulse pressure rate1.4% versus 0.9% (P=0.007); blood in mucus 3.3% versus 0.9% (P<0.001). Conclusions.. This study demonstrated that minimally invasive airway suctioning in intubated ICU-patients had fewer side effects than routine deep endotracheal suctioning, without being inferior in terms of duration on intubation, length of stay, and mortality. [ABSTRACT FROM AUTHOR]

Objective.. Many patients have an unpleasant recollection of routine endotracheal suctioning after discharge from the Intensive Care Unit (ICU). We hypothesized that through minimally invasive airway suctioning discomfort and stress may be prevented, resulting in less recollection. Design.. A prospective randomized clinical trial. Setting.. Two ICUs at the University Hospital of Groningen, the Netherlands. Patients and participants.. Adult patients with an intubation period exceeding 24 h were included. Interventions.. Patients received either routine endotracheal suctioning (RES) or minimally invasive airway suctioning (MIAS) during the duration of intubation. Measurements and results.. Within 3 days after ICU discharge all patients were interviewed, regarding recollection and discomfort of suctioning. The level of discomfort was quantified on a visual analogue scale (VAS). We analyzed data from 208 patients (RES: n=113, and MIAS: n=95). A significantly lower prevalence of recollection of airway suctioning was found in the MIAS group (20%) compared to the RES group (41%) (P-value =0.001). No significant difference in level of discomfort was found between the RES and the MIAS group (P-value =0.136). Conclusions.. Minimally invasive airway suctioning results in a lower prevalence of recollection of airway suction than in RES, but not in discomfort. [ABSTRACT FROM AUTHOR]

We present a new case of analbuminemia accompanied by severe lipodystrophy in a young woman. Albumin concentration was below 200 mg/l serum (i.e., less than 0.5% of physiological) as measured by kinetic immunonephelometry, but this was partially compensated by increased circulating levels of both positive and negative acute-phase proteins and of secretory proteins such as cholinesterase. This appears to be the first report describing successful correction of analbuminemia-related lipodystrophy by ultrasound-assisted lipoplasty where, in the first session, around 7800 ml fat was aspirated. The possible relationships between the diagnosed disturbances in lipid metabolism (type IIa hyperlipoproteinemia, increased free fatty acids) and the severe dysregulation in lipid deposition are discussed. [ABSTRACT FROM AUTHOR]

Unlabelled: The objective of the study was to compare prospectively short-term and mid-term results after ACL reconstruction with special focus on changes in instrumented knee laxity. Methods: The original study group included prospectively 58 patients who underwent arthroscopically assisted ACL reconstruction with BPTB graft in a two-tunnel technique between 1991 and 1993. Seven patients were lost to follow-up, leaving 51 patients for a first follow-up at 6 months and a second follow-up at 3-6 years (mean 4.3 years). Clinical results were evaluated by means of the Lysholm score and the IKDC score. Laxity was assessed using a KT-1000 arthrometer applying an 89 N anterior load in 20 degrees of flexion. Increased laxity was defined as a 3 mm increase in AP translation between the first and the second follow-up. Results: At mid-term follow-up pivot shift was negative in 86% of cases. IKDC score: normal = 28%, nearly normal = 44%, abnormal = 24%, severely abnormal = 4%. KT-1000: < 3 mm = 68%, 3-5 mm = 24%, > 5 mm = 8%. The mean KT-1000 side-to-side difference was 1.08 (0.17) mm at 6 months and 2.01 (0.29) mm at 3-6 years. The difference was statistically significant (P < 0.005). According to the defined criteria, seven patients had increased laxity at the second follow-up, suggesting a malfunction of the graft due to stretch-out or injury. In this subgroup the mean KT-1000 measurements were 0.86 (0.26) mm at the first follow-up and 5.93 (0.54) mm at the second follow-up. In five of these patients, a malposition of the tunnels was identified as a possible cause. In the remaining group, KT-1000 measurements did not differ significantly between the first and the second follow-up [1.12 (0.20) mm versus 1.37 (0.21) mm]. Conclusions: Increase in AP laxity occurred in 14% of our cases between the first and the second follow-up. In most of these cases increased laxity was due to inadequate surgical technique, especially malposition of bony tunnels. If tunnel position was correct, there was no evidence for elongation of grafts over time as a general principle. [ABSTRACT FROM AUTHOR]

Abstract  Myositis of the gluteal region caused by group A streptococci 1 year after a sacrospinous ligament fixation was recognised as a serious complication of this procedure. Most likely, the infection was spread to the gluteal region through a port d’entree caused by vaginal atrophy, via the non-resorbable sutures. The patient was treated successfully with antibiotics intravenous and local estrogens. [ABSTRACT FROM AUTHOR]

A case of multicentric giant cell tumor with synchronous occurrence in all three bones around the knee is reported here in view of its rarity. A 33-year-old average built male reported with complaints of severe pain, gradually increasing swelling around the right knee. A 3 x 2 cm swelling was present on the lateral aspect of the distal end of the right femur and a 3 x 3 cm swelling on the proximal part of the right tibia. Plain X-ray of right knee showed subarticular eccentrically located expansile lytic lesion in the lateral tibia condyle, lateral condyle of femur and patella. Fine needle aspiration cytology and subsequent histology ascertained the diagnosis of giant cell tumor of the bone. The patient was treated successfully with curettage, bone grafting and methyl methacrylate cementing (Sandwich technique). [ABSTRACT FROM AUTHOR]

Background: Curettage and wide resection are accepted methods of treatment of giant cell tumor (GCT) of bone. The success rate with curettage in different reports varies widely. There is a paucity in the literature regarding selection of cases for curettage. Present study is an analysis of outcome of 34 cases treated by curettage and bone grafting. Materials and Methods: Thirty-four cases of GCT of bone, 28 fresh and six with recurrence were treated by curettage and bone grafting. All cases of Campanancci grade 1, 2 and grade 3 which on computerized tomography scan showed break in the cortex confined to one surface and cortical break less than one third of circumference were treated by curettage and bone grafting. Results: 4 (14%) of these lesions treated primarily by us showed recurrence after one and half year. Conclusion: Curettage and bone grafting is a reliable method in the treatment of GCT, provided guidelines regarding selection of cases and principles of tumor surgery are strictly adhered to. [ABSTRACT FROM AUTHOR]

Pseudo-cyst formation is a rare complication after abdominoplasty. These cysts were first described in 1853 by Morel-Lavalee in the lower limb. Abdominoplasty combined with liposuction is a very common aesthetic procedure for body contouring. A case report of the diagnosis, investigation, surgical management and long-term follow-up of this rare complication is presented in a patient who had an abdominoplasty combined with liposuction. [ABSTRACT FROM AUTHOR]

This article presents statistical data on abortions in the U.S. Since 1979, there have been between 1.5 million and 1.6 million legal abortions in the country, with 83% of unmarried abortion clients in 1991. The majority of abortions involved women between 20 and 29, but one in four were teenagers. Ethnic distribution of the unmarried women who had abortions in 1992 revealed that 41% are Non-Hispanic white. Two-thirds of the abortion clients had previously borne a child. Nearly half had at least one previous abortion. Most are poor and uneducated. Ninety percent of the 1992 abortions took place in the first trimester of pregnancy, the period excluded from legislative regulation by Roe v. Wade. Ninety percent were performed by suction curettage.

A possible method for reducing complications after legally induced first-trimester abortions was sought. One hundred-seventeen patients participated in the study and had the gestational age determined by ultrasound before evacuation. The aspirated amount of tissue was measured and a definite correlation was made to the seventh to twelfth week of gestation respectively. It is concluded that at least 15 ml tissue should be evacuated in the seventh to eight week, 25 ml in the ninth to tenth week, and 35 ml in the eleventh to twelfth respectively. [ABSTRACT FROM AUTHOR]

The article presents the case of 54-year old woman with chalazion-induced hypermetropia at her right upper eyelid. Computerized corneal topography revealed a central corneal flattening that corresponds to the position of the chalazion. Results of other examinations are discussed. Incision and curettage methods are recommended to be used in cases significant chalazion to produce visual improvement.

Supernumerary nipples and breast tissue often are dismissed as cosmetic curiosities. These structures have the potential for pathologic degeneration and may be associated with significant congenital abnormalities. In a prospective comparison of 100 Native American women with 100 non-Native American women, these accessory organs were found much more commonly among Native American women. Careful attention should be given to thorough evaluation and long-term follow-up evaluation of any patient with this anomaly. This study investigated a patient who underwent surgical removal of her axillary breast tissue with ultrasound-assisted liposuction. The advantages of this method include a minimal incision scar from the liposuction cannula and the ability to detect residual axillary breast by ultrasound. [ABSTRACT FROM AUTHOR]

In children with cervico-facial nontuberculous mycobacterial infection, the treatment of choice is excision of the whole node. The alternative surgical treatment modality is drainage and curettage via the cutaneous route. However, these approaches include the risks of nerve damage, scarring, and keloid formation. This paper describes an intra-oral approach to the facial node that can greatly reduce these risks. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to determine whether ultrasonography is a reliable method for monitoring subcutaneous fat thickness in the quantitative analysis of liposuction results. Methods: Subcutaneous fat thicknesses before and 2 months after lipo suction in pre specified areas were measured in 14 patients using a 7.5-MHz ultrasound scanner. Pre- and postoperative subcutaneous fat thicknesses were compared statistically. Results: The thicknesses of pre- and postoperative subcutaneous fat layers were statistically different. Conclusion: Ultrasound is a valuable tool for perioperative guidance, preoperative planning, and quantitative analysis of the procedure results. [ABSTRACT FROM AUTHOR]

Features the Cattani Turbo-Smart compact universal suction system. Application of correct vacuum; System requirements; Dimensions of the device.