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Children with symptomatic ileocolic or ileo-ileocolic intussusceptions can be successfully managed in one of a number of different ways. The nonoperative enema reduction technique has major advantages over surgical reduction and high success rates can be achieved using pneumatic or hydrostatic reduction techniques under fluoroscopic or sonographic guidance. This article highlights current concepts and some controversial issues related to management of intussusception, including patient selection for attempted enema reduction, the advantages and disadvantages of each technique, complications, the value of delayed, repeated reduction attempts, the role of imaging after attempted enema reduction, and recurrence of intussusception.

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophic inferior turbinates. In cases of nonresponse to conservative medical management, the surgical reduction of the inferior turbinates is often required. Surgical techniques for the reduction of hyperplastic nasal turbinates include monopolar or bipolar coagulation, partial or total reduction of the turbinates with a conchotome or scissors and laser surgery with Nd:YAG, CO2 or KTP. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngology which is based on high-frequency electrocoagulation with an argon gas source. The fast and short surgery times, the absence of hemorrhagic complications and, in rhinosurgery, the complete abstention from any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgery Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t test was used for statistical data. After 24 months, 87% (p < 0.001) of the patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. The indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery are reviewed and discussed.

We report a rare cause of cervical myelopathy (CM) in a 10-year-old Down syndrome (DS) girl. She presented with progressive CM over 1 year affecting her ability to ambulate or feed herself. The myelopathy was secondary to C2/3 instability. Surgical reduction and instrumented fusion have significantly improved her neurological status. This case emphasizes the importance of close follow-up of DS patients for early diagnosis and treatment of cervical spine abnormalities.

Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were iden tified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used.

The Inferior Turbinate: Dysregulation and Surgical Reduction. Nasal obstruction may be caused by individual anatomy, a dysregulation of the nasal mucosa or, frequently, a combination of both. Persistent allergic inflammation deserves special attention, as initial therapy should not be surgical. The plethora of surgical techniques for the reduction of inferior turbinate volume is a good indicator of unresolved controversies regarding the ideal technique. This review analyses our current knowledge about success and complication rates of different surgical techniques. Many of these techniques have a distinct pro and contra-profile which is acceptable for both the patient and the surgeon. This is a good starting point for randomised clinical trials. The definition of the anterior turbinoplasty as a gold-standard for future trials is proposed.

Background The CO2-laser-surgical reduction of the hyperplastic nasal turbinates represents a standard procedure in ENT-Surgery. In the presented paper, the authors introduce a new technique for the treatment of hyperplastic turbinates. Methods The laser beam is transmitted through a 90 degrees handpiece to the mobile "infra-guide" wave guide, which contains a 1 mm ceramic tube. By application of mirrow pieces with different angles, laser surgical reduction of those parts of the nasal turbinates is possible, which normally can not be reached by conventional, tangentially to the mucosa directed laser beams. The direction of the laser beam is controlled either optically, as in endonasal sinus surgery, or monitored through a camera. A total of 36 patients (22 women, 14 men, mean age 32.7 years) with nasal turbinate hyperplasia and either impaired nasal breathing and/or retronasal drip were treated with the new method. Results The laser wave guide represents a minimally invasive and basically complication-free method feasable on an outpatient basis. As a particular advantage, laser surgical reduction of the posterior parts of the inferior and also the middle turbinate is possible. The majority of the patients relates of an improvement of the preoperative symptoms (regarding reduction of impaired nasal breathing: 61.3 %, regarding reduction of post nasal drip 87.1 %). Conclusion The laser wave-guide represents a basically complication-free, minimally invasive supplement to the different treatment modalities of the hyperplastic nasal turbinates.

Background: Nasal obstruction is a common complaint in ENT clinics and significantly affect the patient`s quality of life. Inferior turbinate hypertrophy is one of the common causes of nasal obstruction, surgical reduction of inferior turbinate is indicated in refractory cases not responding to conservative measures and the optimal surgical technique is controversial. The aim of the study was to evaluate the clinical outcomes of powered endoscopic inferior turbinoplasty in the management of inferior turbinate hypertrophy. Methods: An interventional study (single group clinical trial) was conducted and powered endoscopic inferior turbinoplasty was performed on 30 patients complaining of chronic nasal obstruction due to inferior turbinate hypertrophy and other causes of nasal obstruction were excluded. Results: Assessed preoperatively and 1st week, 1st month and 3rd month postoperatively depending on subjective visual analogue scale scores for nasal obstruction, endoscopic grading system and complications. There was significant improvement in nasal obstruction and significant reduction in inferior turbinate size and mild complications that completely absent at the third month following the surgery. Conclusions: Microdebrider-assisted inferior turbinoplasty as a safe, effective and reliable alternative method for inferior turbinate reduction.

To analyze early postoperative period in patients with diffuse pulmonary emphysema after palliative surgical correction of respiratory failure.The study included 196 patients who underwent bullectomy (n=111) and surgical reduction of pulmonary volume (n=85).Overall morbidity and mortality were 40.8% and 12.2% respectively. Among patients older than 60 years these values were significantly higher (58.0% and 22.6% respectively). It was shown that age over 60 years is associated with high risk of complications and mortality after excision of large and giant bulls. In patients60 years morbidity is comparable after bullectomy and surgical reduction of pulmonary volume.Selection of patients for palliative surgical correction of respiratory failure is generally corresponded to that for lung transplantation. However, these methods should be considered complementary rather competing.Цель исследования - анализ раннего послеоперационного периода у пациентов с диффузной эмфиземой легких после паллиативной хирургической коррекции при дыхательной недостаточности. Материал и методы. В исследование включены 196 пациентов, которым выполнены буллэктомия (n=111) и хирургическая редукция объема легких (n=85). Результаты и обсуждение. Среди всех оперированных частота осложнений и случаев летального исхода составила 40,8 и 12,2%. В группе пациентов старше 60 лет эти показатели существенно выше (58,0 и 22,6%). Показано, что возраст пациентов старше 60 лет является критерием, связанным с высоким риском осложнений и летального исхода после удаления крупных и гигантских булл. Частота послеоперационных осложнений у пациентов моложе 60 лет после буллэктомии и хирургической редукции объема легких сопоставимы. Вывод. Отбор пациентов для паллиативной хирургической коррекции при дыхательной недостаточности в целом соответствует принципам отбора для трансплантации легких, но эти методы должны рассматриваться не как конкурирующие, а как дополняющие друг друга.

Thoracolumbar fracture-dislocations are devastating injuries. They usually require surgical reduction and stabilization. The authors present a novel technique for reducing these injuries that is predictable and reproducible.

Excessive enlargement of the tongue, macroglossia, is a well-recognised clinical condition which can pose signifi cant social and health problems. We report a case of a neonate who was born with a tongue grossly enlarged to the point of inability to feed and deformation of the jaw. Despite surgical reduction of the tongue to normal size, there was a persistent nonocclusion of the mouth, making sucking impossible. Physiotherapy did not help and our experience with neonatal jaw osteotomy is limited. We wonder if a prenatal aspiration of the tongue cyst could have forestalled this jaw deformation.Key words: Jaw deformation, macroglossia, neonate

Tibial eminence fractures are a relatively uncommon injury, but most frequently occur in children and adolescents with open physes. Entrapment of the intermeniscal ligament or the meniscus itself can occur in the setting of a tibial eminence fracture and when present, poses a significant obstacle to successful closed or surgical reduction. Identification of these entrapped structures on preoperative imaging may be helpful to the physicians caring for these patients and assist with preoperative planning. We present a case of a 13-year-old male who sustained a tibial eminence fracture while playing football. Review by the orthopedic surgeon identified entrapment of the intermeniscal ligament. Subsequently, a closed reduction attempt under anesthesia prior to surgery was unsuccessful and arthroscopy was needed to remove the entrapped intermeniscal ligament and reduce the tibial eminence fracture. Pre-operative knowledge of entrapped soft tissue structures under the fracture plane, particularly the meniscus and intermeniscal ligament, provides the surgeon with valuable insight as to how to best counsel patients on the success of treatment options, how to best prepare for operative treatment, and can guide the surgeon during open reduction to maximize treatment success.

Idiopathic spinal cord herniation (ISCH), where a segment of the spinal cord has herniated through a ventral defect in the dura, is a rarely encountered cause of thoracic myelopathy. The purpose of our study was to increase the clinical awareness of this condition by presenting our experience with seven consecutive cases treated in our department since 2005. All the patients developed pronounced spastic paraparesis or Brown-Séquard syndrome for several years (mean, 4.7 years) prior to diagnosis. MRI was consistent with a transdural spinal cord herniation in the mid-thoracic region in all the cases. The patients underwent surgical reduction of the herniated spinal cord and closure of the dural defect using an artificial dural patch. At follow-up, three patients experienced considerable clinical improvement, one had slight improvement, one had transient improvement, and two were unchanged. Two of the four patients with sphincter dysfunction regained sphincter control. MRI showed realignment of the spinal cord in all the patients. ISCH is probably a more common cause of thoracic myelopathy than previously recognized. The patients usually develop progressive myelopathy for several years before the correct diagnosis is made. Early diagnosis is important in order to treat the patients before the myelopathy has become advanced.

ObjectivesThis study presents the successful posterior surgical reduction and fusion on a 26-month-old child with chronic unilateral locked facet joint and spinal cord injury (SCI).MethodsA 26-month-old child with chronic unilateral locked facet joint and SCI treated by posterior surgical reduction and fusion. Plaster external fixation was applied and rehabilitation exercise was trained post-operatively.ResultsChronic unilateral locked facet joint was reduced successfully and bone fusion of C4/5 was achieved 3 months after surgery. The function of both lower limbs was improved 1 year after surgery, aided with physical rehabilitation.ConclusionUnilateral locked facet joint in pediatric population is rare. Few clinical experiences were found in the literature. Non-surgical treatment has advantages of not being invasive and is preferred for acute patients; however, it may not be suitable for chronic unilateral locked facet joint with SCI, in which surgical intervention is needed.

The classification and treatment of atlantoaxial dislocations (AAD) remains controversial. Despite existing debate among the literature, it is generally accepted that the treatment of symptomatic AAD should be surgical reduction and fixation. More recently, there has also been acknowledgement among treating surgeons that there are substantial differences between irreducible and reducible AAD, with significant differences between the two groups in terms of the severity of clinical presentation and ideal management [1]. Presently, however, there is little agreement on how best to manage IAAD. Specifically, the importance of anatomical reduction and the method of obtaining proper alignment surgically varies based on the treating surgeon and institution. The purpose of this commentary is to briefly discuss current options for the surgical management of IAAD.

The incidence of fractures is small and less than 3 % of all ankle injuries in modern professional football. Optimum management for the higher-level football player has to address the demand for early and safe return to a high level of activity. Sport-specific evidence for best practice is limited. A thorough history, examination and adequate imaging are essential to correctly diagnose injuries and decide on best treatment. Early rehabilitation can allow early return to sport within 2–4 months. Surgical reduction when indicated and provision of stability by fixation can allow this and appear to be advisable to optimise both the outcomes and return to competition in football-related ankle fractures.

Clinical management of talar neck fractures is complex and fraught with complications. As Gaius Julius Caesar stated: "The die is cast"; often the outcome of a talar neck fracture is determined at the time of injury. The authors believe, however, that better results can be achieved by following some simple guidelines. The authors advocate prompt and precise anatomic surgical reduction, preferring the medial approach with secondary anterolateral approach. Preservation of blood supply can be achieved by a thorough understanding of vascular pathways and efforts to stay within appropriate surgical intervals. The authors advocate bone grafting of medial neck comminution (if present) to prevent varus malalignment and rigid internal fixation to allow for joint mobilization postoperatively. These guidelines may seem simple, but when dealing with the complexity of talar neck fractures, the foot and ankle surgeon needs to focus and rely on easily grasped concepts to reduce poor outcomes.

Introduction Il existe peu de donnees concernant les resultats et la satisfaction des patientes apres nymphoplastie de reduction. L’objectif de cet article est de decrire les resultats de la chirurgie de reduction de l’hypertrophie des petites levres.

The largest possible and safe removal of the lesion (also malignant) is the best first step of treatment. The extra-axial benign lesions do require the best possible surgical treatment, ideally a complete resection of the lesion without endangering the surrounding neural and/or vascular structures. The most frequent extra-axial intracranial tumours are: pituitary tumours, craniopharyngiomas, central skull base meningiomas, chordomas, chondrosarcomas, trigeminal schwannomas, and schwannomas of the CNs VIII. The outmost surgical reduction of the size of the lesion is highly welcome regardless of whether the tumour is intra-axial and/or extra-axial. Complementary treatment can be much more effective following a successful surgical resection of the lesion. There is no doubt that biological treatments will eventually replace the present day surgical interventions. But at the moment, this is still most effective and the only treatment which can be offered to the patients with intracranial tumours.

We present nine panfacial fractures that were treated during a two-year period in which the first step in treatment was reduction of condylar fractures. There was no evidence of dental or skeletal alterations and measurement of the mandibular ramus and radiographic examination show that posterior facial height as well as projection and width of the inferior lower third of the face, was restored. The correct timing of surgical intervention and the use of rigid fixation allows the restoration of the morphological and functional nature of the face after panfacial fractures.

Neurologically impaired children with orofacial dysfunction may present with problematic drooling. Surgical endeavors to control this problem have consisted of either ablating nerves leading to the salivary glands, affecting salivary drainage, or removal of the salivary glands themselves. This article compares 2 surgical approaches on the basis of parental satisfaction. The submandibular duct rerouting procedure is compared with the submandibular gland excision and sublingual gland debulking procedure. The sublingual gland debulking procedure is described and pertinent anatomy discussed. Eighteen neurologically impaired children ranging in age from 5 to 15 years of age were studied. From 1987 to 1991, 7 children underwent bilateral submandibular duct rerouting procedures. From 1991 to 1995, 11 children underwent bilateral submandibular gland excision and sublingual gland debulking procedure. Because of the parental concern about the long-term efficacy of the submandibular duct rerouting procedure in some children, the surgical approach offered to these children was changed in 1991. Four children are in the "rerouting" group and the "excision group," and therefore served as their own controls. The outcome being monitored was that of parental satisfaction and their assessment of several parameters. These assessments were obtained retrospectively at least 1 year after the surgical procedure was undertaken. Parental satisfaction was higher in the "excision" group of children as compared with the satisfaction expressed by parents in the "rerouting" group. Parameters assessed were: effectiveness of the procedure (0%–90% reduction in salivary flow), difficulty in tolerating the procedure, and willingness of the parent to have the child undergo the procedure again. On the basis of a parental-satisfaction survey, children who underwent the submandibular gland excision with the sublingual gland debulking procedure tolerated the procedure more easily, experienced greater reduction in salivary flow, and their parents were more willing to submit their child to the procedure again in comparison with the parents of children who were treated with the submandibular duct rerouting procedure.

Cervical intervertebral disk disease is commonly treated surgically by ventral decompression through a ventral slot. Nine dogs with documented vertebral subluxation following surgical creation of a ventral slot are reported. The location of the subluxation was at the fourth cervical (C4) to fifth cervical (C5) intervertebral space in two dogs, C5 to sixth cervical (C6) intervertebral space in four dogs, and C6 to seventh cervical (C7) intervertebral space in three dogs. The ventral slot width to vertebral body width ratio ranged from 0.39 to 0.80, with the ratio being 0.50 or greater in seven of eight cases evaluated radiographically. Surgical reduction and stabilization were performed in seven of nine dogs.

There is little debate about the primacy of surgery in the management of classical PHPT. Rather, the question has been what to do about the many patients with nonclassical disease. A 1990 NIH consensus conference (55) clearly recommended surgery for patients with significant adverse effects of PHPT, for patients with complicating coexistent illnesses, for younger patients, and for those in whom consistent long-term follow-up could not be assured. It allowed that conscientious surveillance may be justified in patients with minimal hypercalcemia and no adverse effects, but it recognized that for many patients, the time and expense involved in rigorous follow-up would outweigh the burden of surgery. Nine years later, the demonstrated prevalence of nonclassical symptoms and their reversibility, the evidence of "asymptomatic" but harmful effects reversible by surgery, and the accumulating evidence for surgical reduction of increased long-term mortality risk substantially strengthen the argument for surgery in such patients. For these reasons, parathyroidectomy should generally be recommended for patients with a secure diagnosis of PHPT, even in the absence of classical symptoms.

Operative cases in thoraco-lumbar fracture-dislocations were investigated. Nine males underwent surgical reduction, decompression and posterior instrumentations using ISOLA in 7 patients and VSP in 2 from June 1993 to July 1998. The age at the surgery ranged from 24 to 49 years old (average 33 years old) and follow-up period from 4 months to 65 months (average 17 months). The dislocated vertebrae ranged from T9 to L2 and 3.4 vertebrae on average were included into fusion area. Four patients underwent urgent operations and 5 patients elected operations.The duration of bed rest averaged 2 weeks. Six patients represented complete paraplesia preoperatively and no one improved postoperatively. Three patients with incomplete paraparesis improved completely (2 patients D→E, 1 patient B→E). After surgery the mean kyphotic angle before, justafter, at follow-up were 12°, 0°, and 4° respectively. Therefore good reduction was achieved and the correction loss was small. Three patients complained of persistent girdle pain of the torso but there was no relation with the correction loss of the kyphosis after surgery.

The authors report an observation of a rare case of vulvar tuberculosis in its hypertrophic form it is observed in a 16-years-old girl. The diagnosis was retained on a beam of arguments anamnestic, clinical, histological and evolutionary. A medical treatment based on antibacillar was founded supplemented of a surgical reduction for aesthetic concern.

Gynecomastia correction is the most common breast surgery in males.1 Surgical reduction is indicated in Grade IIB and Grade III gynecomastia in Simon's classification.2 A circumareolar incision may chosen according to skin and areolar excess. Achieving a symmetrical nipple-areola complex is one of the major goals of the reduction surgery. The average areola diameter of males is measured as 2.67–2.8 cm in anatomical studies.3,4 Using the parts of 50 cc syringes as templates is appropriate for measuring the …

Arytenoid dislocation is commonly misdiagnosed as vocal fold paralysis. Accurate, early diagnosis increases the likelihood of easy surgical reduction and good functional outcome. However, successful reduction can be accomplished even many years after arytenoid dislocation. Anterior, posterior, and complex dislocation can occur. Different surgical techniques are appropriate for each arytenoid malposition.

Controversies still exist about the preferred treatment of condylar head and neck fractures. Newly developed access techniques in combination with new methods to fix the fragments, lead to satisfactory results. This study deals with a refinement of surgical treatment of intracapsular fractures.

We assessed the effectiveness and safety of surgical reduction of the inferior turbinate in 64 children, ages three to 15 years, who were operated on between January 1985 and November 1995. All patients/parents were interviewed and assessed by means of a questionnaire one to 10 years postoperatively. All patients had follow-up and were evaluated clinically at one and two weeks postoperatively. Long-term follow-up visits occurred at six, 12 and 24 months. Eighty-nine percent of the children/parents reported a sustained improvement in their nasal airways. No cases of serious postoperative hemorrhage, excessive dryness nor long-term crusting of the nose were observed or reported. We conclude that in the treatment of children with severe nasal obstruction, surgical reduction of the inferior turbinate is a safe and effective operation, alone or in combination with other airway procedures, and may increase the effectiveness of subsequent medical management.

We reviewed the results of 15 knees in 11 patients who underwent semitendinosus transfer (Uezaki's procedure) at Fukuoka Chilyden's Hospital and Medical Center from 1983 to 1996. Five patellae were permanent dislocations, 2 were recurrent and 8 were habitual. The mean age at the time of the operation was 8.1 years, and we examined the results after an average follow-up period of 5.3 years.According to our own clinical evaluation methods, the results were satisfactory in 12 knees and unsatisfactory in 3 knees.We examined the sulcus angle, tilting angle, congruence angle and the lateral shift ratio on X-rays. Most angles and ratios decreased except in the 3 unsatisfactory cases.In the 4 unilateral cases, we found that the earlier surgical reduction was performed on the patella, the better the improvement in the shape of the sulcus of the patellar groove.For the purpose of earlier diagnosis, we examined patello-femoral congruity on MRI scans of 1 case with nail-patella syndrome whose patella was not able to be viewed on X-rays.We concluded early diagnosis and operative reduction was extremely important for the treatment of dislocation of the patella in children.

This paper addresses the diagnostic and therapeutic implications of increased probing depths. In general, in untreated and treated patients, when deep and shallow probing depths are compared, the data indicate that deep sites are associated with increased bleeding upon probing, elevated subgingival temperatures, higher levels of pathogens, more probing errors, a greater amount of infiltrated connective tissue, reduced ability to remove subgingival deposits with root planing, and diminished effectiveness of oral hygiene to alter the subgingival microbiota. Clinical trials demonstrate that probing depth is not a good predictor of future disease progression. However, deep sites are at greater risk of disease progression than shallow sites in untreated and treated patients. Furthermore, the deeper the probing depth, the greater the risk of future disease progression. Overall, the preponderance of evidence indicates that it is advantageous, but not always necessary, for patients to have shallow probing depths. With regards to surgical reduction of probing depths beyond that attained with non-surgical therapy, clinicians need to consider the advantages (e.g., ease of maintenance, reduced risk of disease progression) and disadvantages (e.g., root sensitivity, cosmetic defects) of treatment procedures. Since numerous variables require consideration (e.g., response to root planing, goals of therapy, acceptable level of risk for future disease progression), treatment decisions will vary depending on the patient and the desired clinical outcome at specific sites.

This case report and literature review examines whether closed reduction is a viable option to manage hip dislocation when the patient has a constrained liner. Introduction Dislocation after total hip arthroplasty (THA) ranges from less than 1% to 6% of primary cases [1] and from 15% to 30% of revision cases [2]. Unfortunately, the success rate of non-operative treatment of dislocation after THA can be unreliable, and a third of such patients have recurrences [1]. Surgical procedures used to treat instability and dislocation include: •Tightening the abductor musculature •Removing sources of impingement •Repositioning malaligned components •Using acetabular liners with elevated rims Such treatments fail in 30% to 50% of patients, however [3]. The use of constrained liners, which relies on a locking mechanism to capture the femoral head, has been developed to help manage this problem [4]. Despite such efforts, patients continue to be at high risk for instability, and 3% to 18% experience recurrent dislocation even after constrained components have been implanted [5,6]. Generally, open surgical reduction is thought to be the only available treatment for such cases. However, this compromises the integrity of the joint and exposes the patient to the additional risk of surgery [7]. Several authors have reported closed reduction for dislocation of a constrained liner [7-13]. Constrained acetabular liners are currently available in various designs, with differences in the locking mechanisms. To our knowledge, ours is the first reported case of a successful closed reduction of a dislocated constrained THA using a Trilogy Acetabular System Constrained liner (Zimmer, Inc, Warsaw, Indiana, USA). The study protocol adhered to the ethics guidelines of the 1975 Declaration of Helsinki, and the study was approved by the Institutional Review Board of Stanford University.

We treated a patient with a rare combination of ipsilateral fractures of the distal and proximal ends of the radius. A man aged 42 years had simultaneous fractures of the distal and proximal ends of the radius (radial neck) following a roadside accident. The distal end fracture of the radius was treated with surgical reduction and T-plate volar fixation, and the undisplaced radial neck fracture was treated by an above elbow splintage for 2 weeks. The elbow mobilization was started at 2 weeks. The distal radius was protected for another 4 weeks in a below elbow functional brace. Ipsilateral proximal and distal radial fracture is an uncommon injury pattern. The series illustrates a number of problems associated with this combination. Firstly, one should be aware of this rare injury pattern and there should be greater emphasis on clinical examination of elbow in cases of wrist injuries and vice versa. Once diagnosed, one faces the dilemma of appropriate management in these cases. The appropriate management will depend on the injury characteristics including the age of the patient and the fracture pattern. One should try to preserve the radial head to prevent a possible proximal radial migration especially in younger patients.

A 38-year-old male presented to the emergency room suffering acute pain in his left eye. Two months before he had been submitted to uneventful non-penetrating deep sclerectomy and one month before to YAG-laser goniopuncture. Examination showed iris herniation into the trabeculo-descemet’s window. Surgical reduction was carried out through a peripheral corneal incision, and a large air bubble was injected into the anterior chamber. Four days later a wide laser peripheral iridotomy was performed. This technique can transform a non-penetrating technique into a full-trabeculectomy, without reopening the superficial flap.

Twenty patients with a subtalar dislocation of the foot are reported in this series. Thirteen cases had medial subtalar dislocation, 4 lateral, 2 posterior and 1 anterior. Open dislocation occurred in 2 cases. Manual reduction was successful in 16 cases and surgical reduction was necessary in 4. A short leg cast was applied for 3–6 weeks. There were no cases of aseptic necrosis of the talus. Excellent results, in terms of Hawkins' criteria (J Bone Joint Surg 1970; 52A: 991–1002), were achieved in 15 cases and good results in 5. Medial subtalar dislocation can be classified into two types: swing and shift. Most swing type cases showed features making their fractures irreducible, such as interposition of a tendon or retinaculum.

A case of acromegaly accompanied by pituitary adenoma in a 39-year-old woman was reported. Her manifest conditions in the field of oral surgery were jaw asymmetry, mandibular protrusion, hypertrophy in the right condyle, and macroglossia. Prior to oral surgical reduction, pituitary tumor was resected by the transsphenoid approach at the Department of Neurosurgery and growth hormone was controled almost at the normal level thereafter. Surgical reduction was performed by right condylectomy, partial glossectomy, and bilateral sagittal split ramus osteotomy for mandibular set back. After surgery, the oral conditions improved, without disturbances in chewing, mandibular opening or closing, and esthetic appearance. However, further follow up is needed in cases like the present one.

Congenital dislocation of the knee (CDK) is not a common condition, and in most cases, reduction is performed by closed methods. We present two children with CDK who were refractory to conservative treatment. Surgical reduction was performed, and quadriceps lengthening was done by VY plasty in one and Z plasty in the other. At operation, it was difficult to identify the different muscle groups. Abnormal fibrous tissue was present in both the cases beneath the contracted quadriceps, which required complete excision. The child with Z plasty to lengthen the quadriceps had better range of motion in the knee than did the one with VY plasty.

Liposuction of the breast in combination with vertical mammaplasty was applied to 250 breasts among 386 reductions of large breasts performed in 2 years (1989 to 1991). To evaluate the possible damage to the breast caused by this combined procedure, especially in terms of the occurrence of the postoperative development of calcifications, a comparative study of preoperative and postoperative mammograms was undertaken in 60 randomly selected cases (120 breasts), 34 with and 26 without liposuction. Altogether, 13 calcifications (11 percent) were discovered during the 6- to 30-month follow-up, representing the lowest rate reported in the literature. Deep intraparenchymal calcifications were more frequent after liposuction; most (5 of 7) were macrocalcifications. None could be confused with malignant calcifications because they were more scattered, more regular, and less numerous. Attempts to evaluate the fat content of breasts via preoperative mammography failed to prove this examination a useful way to predict the viability of breast liposuction.

RESUMENEn la bibliografía se han reportado alrededor de medio centenar de casos de luxaciones lumbosacras; la mayor parte se tratan de luxaciones facetarias bilaterales. Presentamos el caso de una paciente mujer de 42 años con luxación facetaria unilateral lumbosacra de un mes de evolución tras accidente de tráfico. Se realiza artrodesis circunferencial L5-S1 instrumentada con caja intersomática y tornillos pediculares L5-S1. La luxación lumbosacra es una lesión poco habitual que se produce gracias a la combinación de un mecanismo de alta energía con factores anatómicos predisponentes. Recientes publicaciones defienden la reducción quirúrgica y estabilización con instrumentación como tratamiento estándar.Palabras claveLuxación; unión lumbosacra; artrodesis ABSTRACTIn the literature have been reported around fifty cases of lumbosacral dislocations; treated most bilateral facet dislocations. We report the case of a female 42 year old with unilateral lumbosacral facet dislocation of one month duration after accident. Circumferential instrumented fusion L5-S1 with interbody cage and pedicle screws L5-S1 was performed. The lumbosacral dislocation is a rare injury that occurs due to the combination of a high-energy mechanism predisposing anatomical factors. Recent publications advocate the surgical reduction and stabilization with instrumentation as standard treatment.Key WordsDislocation; Lumbosacral junction; Arthrodesis.

The authors report a case of amyloidosis-induced macroglossia treated with surgical reduction of the tongue using a keyhole to inverted T method with particular emphasis on the postoperative sequelae. Significant tongue swelling persisted for longer than anticipated requiring tracheostomy to remain in situ for 14 days.

SummaryTwo young dogs examined for hindlimb lameness were found to have healed femoral fractures, 2-4 cm of femoral shortening, and 1 cm of compensatory ipsilateral tibial overgrowth. Neither dog had had surgery or internal fixation. Although tibial overgrowth partially corrected for limb shortening, both dogs had chronic intermittent lameness due to malformation of the femoral condyles and secondary stifle osteoarthritis.Compensatory tibial overgrowth was found in two young dogs with femoral fractures which had healed without any surgical reduction or internal fixation. Tibial overgrowth of approximately 1 cm in each case partially compensated for 2-4 cm of femoral shortening.

The two provocative essays in this issue of the Hastings Center Report should stimulate debate not only about female genital cutting, fetal dexamethasone, and clitoral reduction surgery, but also about our fierce commitment to particular cultural norms about the body. Under what conditions may adults irreversibly modify a child's body because they think the change is in her best interest? Certainly, parents who opt for female genital cutting or for surgical reduction of an enlarged clitoris in a girl with congenital adrenal hyperplasia want to make choices that will contribute to their child's potential happiness. If cutting in Africa—or mitigating CAH symptoms here—upholds a girl's gender identity, which will translate into a fulfilled life as an adult, some argue that a parent's refusal to abide by social prescriptions does the child a serious disservice.

Objective Myelomeningocele is a defect that typically is repaired surgically within the first few days of life in developed countries to minimize the risk of meningitis. If left unrepaired, these children may survive to have their meningocele sac epithelialize. The surgical reduction and closure of an epithelialized myelomeningocele represents a unique challenge for the neurosurgeon because it requires a modification of the typical closure technique. Methods Our 10 years' experience in 97 patients with the delayed (>6 months) repair of myelomeningoceles formed the basis of this report. Results We present repair techniques in a child with a myelomeningocele that was not repaired at birth and presented a surgical challenge. Conclusion Delayed closure of myelomeningoceles is facilitated by lessons learned from our surgical experience during a medical missions to Guatemala.

To show the outcomes of surgical reduction of ocular pigmentation in patients with oculodermal melanocytosis.Surgical reduction of ocular pigmentation was performed in 49 patients with oculodermal melanocytosis at the Asan Medical Center, Seoul, Republic of Korea, between January 2005 and January 2009.In all patients, ocular pigmentation was cosmetically reduced, and most patients were satisfied with the results of surgery. Preoperative and postoperative visual acuities, intraocular pressure (IOP), keratometry, and refractive outcomes did not differ significantly. During the follow-ups, 14 patients showed transient IOP elevation and 4 patients showed conjunctival neovascularization.Surgical reduction of oculodermal melanocytosis seemed to be cosmetically satisfactory and did not cause significant changes in visual acuity, refraction, or keratometry, although 28.6% (14 of 49) of patients showed transient IOP elevation.

Lymphangioma is a benign, hamartomatous tumor of the lymphatic channels. It is usually found in the head and neck region. Most lymphangiomas are present at birth and are usually diagnosed in infancy or early childhood. When lymphangioma occurs in the mouth, the anterior two thirds of the tongue is the most commonly affected region. A risk of secondary growth is classically described after surgical reduction. In this paper, we present 9 cases of tongue lymphangioma. We provide a literature review of tongue lymphangioma.

Surgical reduction of fractures involving the orbits, nasoethmoid complex, and adjacent cranium is challenging; adequate initial reduction and stabilization is essential because secondary reconstructive procedures usually provide less than satisfactory results. Our operative techniques for surgical exposure, as well as fracture reduction and fixation, have evolved from standard facial incisions and wire fixation to complete exposure of the orbits, nasoethmoid complex, and adjacent cranium using an extended bicoronal approach, application of ridged plating techniques, and cranial bone grafts when needed. This evolution of surgical technique has been accompanied by an overall improvement in immediate cosmetic and functional results.

BACKGROUND Congenital dislocation of the hip (CDH) and congenital dislocation of the knee (CDK) occurring in the same extremity is a rare condition. Traditional treatment usually involves staged procedures, obtaining knee reduction first, and then addressing the hip once the knee can be flexed adequately. Simultaneous surgical reduction of both dislocations assisted by femoral shortening is a logical treatment option not previously reported. METHODS A retrospective radiographic and clinical review of surgically treated patients was performed, with a minimum 5-year follow-up. Outcome of CDK treatment was graded according to a scale consisting of radiographic congruity, clinical stability, function, and gait. Outcome of CDH treatment was graded according to Severin classification. RESULTS Eight patients (11 limbs) were identified, with follow-up of 5 to 16 years. Four patients (5 limbs) underwent simultaneous open reduction of both dislocations stabilized by capsulorrhaphy and femoral shortening, with 3 patients operated at age 1 year. Subsequent procedures included 2 physeal-sparing anterior cruciate ligament reconstructions, and 1 high tibial osteotomy to correct angular deformity. Additional procedures for hip dysplasia included 2 pelvic osteotomies in the same patient. Four patients (6 limbs) underwent staged treatment: open reduction of the knee using quadricepsplasty at age 4 to 11 months, followed by open reduction of the hip by either medial approach 3 months later, or anterior approach 12 to 24 months later. No additional knee procedures were performed in this group. Additional hip procedures included 1 repeat open reduction and 1 pelvic/femoral osteotomy. At follow-up in the simultaneous group, knees were 3 excellent, 1 good, and 1 fair, whereas hips had 3 Severin grade 1 to 2 results, 1 grade 3, and 1 grade 4. Outcomes for the staged group knees were 2 fair and 4 poor results, whereas hips had 5 grade 1 to 2 results and 1 grade 3. CONCLUSIONS Outcome for CDK treated simultaneously seems better than staged treatment due to improved retained quadriceps function and attention to teratologic instability. Outcomes for CDH were essentially equal regardless of simultaneous or staged treatment. LEVEL OF EVIDENCE : III.

Traumatic facet dislocation of the lumbosacral joint is uncommon. This report of a bilateral L5-S1 facet dislocation is compared with prior reported unilateral and bilateral cases with respect to mechanism of injury, neurologic injury, surgical reduction and fixation, and clinical outcome. Attention to the disk injury is recognized as essential to prevent cauda equina or root compression after reduction and fixation of the dislocation.