Alternative techniques in the treatment of unilateral coronal synostosis.

Premature closure of one coronal suture results in bilateral abnormalities. There is always ipsilateral flatness of the orbital rim, and contralateral frontal bossing is often found. The authors have employed three operative techniques for correction of unilateral coronal synostosis: frontal bone overlay, lateral canthal advancement, and the tongue-in-groove procedure. The choice of operative technique depends upon the exact deformity to be corrected. The authors believe that altering the relations between the bone and dura by techniques such as radical remodeling and dural plication may improve the results of surgical correction of craniosynostosis.

Rapid management of persistent seromas by sclerotherapy.

Postoperative lymphoceles and adventitious bursae are common occurrences. They are slow to resolve and often persist when traditional techniques of prolonged drainage, multiple aspirations, and local pressure are used. Tetracycline sclerotherapy provides a rational nonoperative alternative treatment that is simple and without major complications and provides a rapid resolution of persistent seromas. Based on our favorable limited experience we believe that this technique should be studied in patients with persistent seromas in a randomized prospective fashion.

The use of Tc-99m MDP bone scanning in the study of vascularized bone implants: concise communication.

The extent to which the nutrient artery alone is capable of maintaining bone growth in the immature animal was studied by excision and reimplantation of the upper tibia in two groups of puppies. In one group the reimplant was totally devascularized, and in a second group attempts were made to preserve the nutrient vessels to the reimplant. Technetium-99m methylene diphosphonate (Tc-99m MDP) was used to assess the effectiveness with which the nutrient circulation was maintained. With one exception the Tc-99m MDP scans proved to be reliable in indicating the potential for continued growth after reimplantation. It was found that the nutrient artery alone is capable of maintaining longitudinal bone growth in metaphyseal reimplants in immature animals. Complete devascularization results in cessation of growth. The Tc-99m MDP bone scan should prove of critical importance in the assessment of free vascularized transplants of immature bone.

Massive unifocal cyst of the liver in a drug abuser: case report and review of the literature.

A 20-year-old white male presented, complaining of abdominal fullness. His previous history was unremarkable except for the use of intravenous illicit drugs. Physical examination disclosed a mass filling the upper and lower right quadrants. We evaluated this mass through the use of barium contrast x-ray, sonography and angiography, and made the preoperative diagnosis of hepatic cystic disease. On operative exploration, a large thin-walled cyst was found on the right lobe of the liver and was shown to be free of communication with the biliary tree; 3,000 cc of chocolate colored fluid were aspirated from the cyst. Total removal of the cyst was achieved with careful dissection. The cavity was filled with omentum and closed with drainage. After a benign immediate postoperative course, the patient remains asymptomatic one year later. Although most reports from the literature describe unexpected intraoperative findings, we stress that symptomatic patients can and should be diagnosed prior to laparotomy, and that a thorough search be made for concomitant polycystic disease. Total extirpation of the cyst is the most desirable of the discussed treatments, when tempered by the age and physical condition of the patient. Thorough preoperative evaluation and awareness of different modalities of therapy allow for the correct choice of treatment.