Minimally invasive endoscopically assisted remodelation (MEAR) of sagittal craniosynostosis: an alternative technique to open and endoscopic procedures with cranial orthosis time span reduction.

INTRODUCTION: Sagittal craniosynostosis represents the most frequent simplex skull suture pathology. There are currently several operative approaches to this defect. Minimally invasive techniques are preferred for young infants. Since July 2017, we have employed endoscopically assisted craniectomies followed by cranial orthosis. Gradually, we have developed our modified technique, the minimally invasive endoscopically assisted remodelation (MEAR). SURGICAL TECHNIQUE: MEAR is a combination of principles gained from classical cranial vault remodeling techniques and minimal invasive approaches. The long and wider lateral osteoectomies performed in the parietal and occipital bones along with loosening of the periosteum and dura adhesions at the lambdoid sutures lead to early correction of parieto-occipital dimensions. RESULTS: Thirty-one consecutive patients with scaphocephaly underwent MEAR. The median preoperative cephalic index of 67 units (P25:63.3, P75:70) was improved to a median postoperative cephalic index of 77 units (P25:75, P75: 81). Sufficient correction was achieved in all patients. Cranial orthosis was needed for a median of 1.5 months (P25:1, P75:2). We had no major surgical complications in this pilot series. CONCLUSIONS: With MEAR, we have achieved good cosmetic results. Duration of cranial orthosis was significantly shortened compared to conventional endoscopic-assisted procedures.

Annular elastolytic giant cell granuloma causes an irreversible disappearance of the elastic fibres.

A 67-year-old man presented with grouped red papules with a smooth surface coalescing to relatively well-demarcated plaques on his left thigh, in the axillae and on the lateral parts of the trunk. The plaques were growing slowly, and the older ones had a frilled surface. A skin biopsy showed a zone of disappearance of the elastic fibres with a rim of giant multinuclear cells with fragments of the elastic fibres in their cytoplasm. This finding is typical of annular elastolytic giant cell granuloma (AEGCG). After corticosteroid therapy, the inflammation resolved, causing the frilled surface of the lesions due to the disappearance of the elastic fibres. Remission of the skin lesions lasted for 1.5 years. A second skin biopsy taken from the site of the previous lesion showed the absence of the elastic fibres, thus their phagocytosis was irreversible.

Vascular surgery in the treatment of impotence; its present possibilities and prospects.

Five years ago we reported on a technique of direct arterial anastomosis with the cavernous bodies of the penis. At that time we expressed the hypothesis that in some cases impotence could be the result of organic changes in the arterial bed supplying the cavernous bodies. A histological study was therefore performed on postmortem material and a new arteriographic technique - phalloarteriography - was developed to visualize the internal pudendal artery, the penile artery and its branches. Bilateral examination carried out in 132 patients with erectile impotence established stenosis or occlusion of these arteries or aplasia of the deep penile artery in most of them. Stenoses or occlusions were either of traumatic (after pelvic fracture) or sclerotic origin in middle aged and older patients or were related to diabetes. In more than 20% of patients with occlusions in the arterial bed plastic induration of the penis (Peyronie's disease) was found. Phalloarteriography has become the basic technique of surgical indication and approach. Revascularization procedures consisted of anastomosis of the inferior epigastric artery to the dorsal penile artery or directly to the cavernous bodies. The results attained in the first 54 patients confirmed the vasculogenic origin of their impotence. The development of phalloarteriography and revascularization procedures contribute to surgical management of impotence and extend the use of vascular surgery.