Barbel Holtmann

A Randomized Comparison of Four Incisions for Orbital Fractures

We previously compared conjunctival and subciliary incisions for exposure of orbital floor and infraorbital rim fractures. A prospective randomized comparison of lower eyelid and orbital rim incisions was then undertaken and results compared with our previous study. Lower eyelid and orbital rim incisions provided more rapid access to fracture sites. Fracture exposure was adequate with all but conjunctival incisions; lateral canthotomy was added in 56 percent of cases to improve exposure. There were minimal or no intraoperative and postoperative complications except for a 42 percent incidence of ectropion following subciliary incisions. Scar appearance was similar in the four groups, except when an isolated conjunctival incision was used, which produced an invisible scar.

A comparison of conjunctival and subciliary incisions for orbital fractures.

Abstract Although complications of conjunctival incisions have been described (Tenzel and Miller, 1971; Converseet al., 1973; Tessier, 1973; Habal and Chaset, 1974; Lynchet al., 1974), there has been no documentation of complications following subciliary incisions. This study was undertaken to compare those 2 most commonly used incisions for exposure of fractures of the infraorbital rim and the orbital floor.

Peripheral Nerve Entrapment Syndromes in Chronic Hemodialysis Patients

15 of 271 patients (6%) treated with chronic hemodialysis developed peripheral nerve entrapment syndrome of the median or the ulnar nerve. The majority of these patients were female (p less than 0.03). Fistulas located in arms with nerve entrapment tended to have higher flow rates than fistulas located in arms without nerve entrapment (57%) vs. 4.4%, p less than 0.001). There was no correlation with the renal diagnosis, previous access surgery in the involved arm, the type of vascular access used, the duration of hemodialysis, the adequacy of dialysis, calcium or phosphate homeostasis, plasma parathyroid levels, or thyroid function. Surgical intervention successfully relieved all symptoms. Return of normal renal function dose not reverse this disorder. Peripheral nerve entrapment is a common surgically correctable cause of neuropathy of the upper extremities in hemodialysis patients.

Clinical treatment of partial tendon lacerations without suturing and with early motion.

Partial lacerations of flexor tendons in chickens come out the strongest and glide best if they are not sutured and not immobilized. We treated 17 patients with 20 partial flexor tendon lacerations by not suturing the tendon and by early mobilization of the digit. These partial tendon lacerations varied from 25 to 95 percent of the cross-sectional area. Sixteen of obtained excellent function of the digit, and one obtained good to excellent function. This technique should be used only in cooperative patients.

Severe Epistaxis in Facial Fractures

The incidence of epistaxis in 312 patients with facial fractures over a 5-year period is reviewed, finding the incidence of epistaxis to be 4 percent in all facial fractures and 11 percent (12 of 108) in midface fractures. Six of these required treatment with packing or transfusion, and two required surgery to control the epistaxis. The only other series reviewing epistaxis in facial fractures reported a similar incidence.

Intrathecal sufentanil (5 vs. 10 μg) for labor analgesia: Efficacy and side effects☆

Background and Objectives. Despite growing popularity, there are few studies examining the relative efficacy of different doses of intrathecal sufentanil for labor analgesia. This prospective, randomized, double‐blind study compared the efficacy and side effects of 5 and 10 μg intrathecal sufentanil. Methods. Sixty‐three healthy, laboring, term parturients ≤5 cm cervical dilation participated in this study. In a randomized, double‐blind fashion, patients received 5 or 10 μg intrathecal sufentanil as part of a combined spinal epidural technique. Patients rated pain, itching, nausea, and sedation on verbal analog scales before and every 10 minutes after drug injection. We also recorded maternal blood pressure and peripheral oxygen saturation before and every 10 minutes after drug injection. Before and 30 and 60 minutes after drug injection, we measured maternal end‐tidal CO2. Results. Both doses of sufentanil provided adequate analgesia. Although 10 μg sufentanil produced slightly more profound analgesia, the duration of pain relief did not differ between the two groups. Both drug doses were associated with significant increases in itching and end‐tidal CO2. The 10‐μg dose was associated with more sedation and a greater decrease in SaO2. Conclusions. Both 5 and 10 μg intrathecal sufentanil provided adequate labor analgesia. Both doses were associated with measurable spinal (itching) and supraspinal (sedation, respiratory depression) side effects.

Selective Shunting During Carotid Endarterectomy Based on Two-Channel Computerized Electroencephalographic/Compressed Spectral Array Analysis

The reliability of selective shunting based on computerized electroencephalographic (EEG) monitoring has not been addressed. In this study, 103 carotid endarterectomies were performed with selective shunting based on a two-channel computerized EEG monitor that processed the on-line, raw electroencephalogram (EEG) to produce a compressed spectral array (CSA). Ischemic EEG events were identified by amplitude attenuation of the raw EEG and/or loss of high-frequency activity on the CSA. Fourteen patients (13.6%) received a bypass shunt, and postoperative neurological examinations showed 97 patients (94.2%) to be intact. A correlation between total (cumulative) ischemic EEG time and the postoperative neurological exam was demonstrated (P less than 0.0001). Six postoperative deficits (5.8%) occurred, five in patients whose computerized EEGs demonstrated an ischemic EEG event late during carotid clamping, when it was no longer possible to place a shunt. The sixth deficit was found in a patient whose EEG did not demonstrate any patient whose EEG did not demonstrate any signs of cerebral ischemia. Five of these six new deficits resolved within 12 hours, and only one persisted for 72 hours, when the patient died of a pulmonary embolism (cerebral infarction and mortality rate of 1%). These results appear to demonstrate that two-channel monitoring of both the CSA and the unprocessed (raw) EEG simultaneously can be used as a reliable indicator of whether a bypass shunt is required during carotid cross-clamping in all patients, regardless of their preoperative neurological history or angiographic findings.

Restoration of Elbow Flexion

The authors review the anatomy, surgical technique and the physical factors involved in the restoration of elbow flexion. They conclude that there are distinct mechanical advantages to Clarks method of transfer of muscle from the pectoralis major.

Trigger finger and thumb, secondary to amyloidosis.

We present a case in which infiltration of the flexor tendons and the fibrous sheaths of the digital flexors with amyloid caused triggering at both the entrance to the fibrous sheaths and at the decussation of the sublimis tendons.

Congenital lip pits and Hirschsprung's disease.

A newborn infant with aganglionosis of the entire colon and terminal ileum also had congenital lip pits and a submucous cleft palate. These anomalies may be added to the growing list of conditions associated with Hirschsprungs disease.