Evaluation of a technique designed to correct nasolabial folds.

This is a long-term follow-up of correction of nasolabial folds in conjunction with face lift that was first published in 1987. In the last 200 face lifts, nasolabial lipectomy has been carried out in 90 percent. Refinements and extensions of the procedure are also described with case illustrations.

Dry ice cryoamputation: a twelve-year experience.

Amputation done on an emergency basis of severely ischemic or infected limbs in critically ill patients frequently results in increased morbidity and mortality. To evaluate the effect of delaying an inevitable operative amputation by a simplified method of freezing the involved extremity, the records of 56 patients who underwent preoperative cryoamputation during a 12-year period were reviewed. Data concerning risk factors, associated medical conditions, local or systemic signs of sepsis, level of amputation, morbidity, and mortality were analyzed. Following cryoamputation of 57 limbs, 16 above-knee amputations (AKA) and 41 below-knee amputations (BKA) were performed. The overall mortality rate associated with cryoamputation was 14% (8 of 57); four postoperative deaths occurred in both the AKA and BKA groups. The mortality rate for 1021 primary operative major amputations during the same period was 7% (p less than 0.04). The only factor identified that significantly affected survival following cryoamputation was diabetes mellitus, which was present in 68% of surviving patients and in 12% of those who died (p less than 0.001). This experience suggests that cryoamputation is a valuable, simple technique that allows for deliberate stabilization and preparation of seriously ill, septic patients prior to surgical procedures, which, when performed on an emergency basis have been associated with mortality rates exceeding 40%.

Reperfusion of the human myocardium by saphenous vein bypass grafts. Biochemical considerations.

The adenine nucleotide content of the human myocardium in the distribution of the left anterior descending coronary artery (LAD) was measured before and after saphenous vein bypass grafting. The purpose of the study were twofold: (1) to relate the level of adenosine triphosphate (ATP) before bypass grafting to the percent stenoses of the LAD and (2) to determine the benefit or lack of benefit of bypass grafting on ATP content. Eighteen patients with angiographically determined LAD lesions of 40% to 100% underwent bypass grafting with standard cardiopulmonary bypass and cardioplegia. Transmural needle biopsy specimens were obtained from the center of the area perfused by the LAD immediately before cross-clamping of the aorta and 30 minutes after reperfusion of the myocardium via the native LAD and the graft. The tissue was divided into thirds: The endocardial and epicardial thirds were analyzed for ATP by high-pressure liquid chromatography and the middle third was viewed by light microscopy. The percent narrowing of the LAD correlated well (r = -0.71) with the ratio of ATP to total adenine nucleotides (TAN) in the endocardium. Epicardial ATP did not correlate with the percent stenoses of the LAD. The endocardial ATP/TAN ratio increased in the group as a whole from 0.51 +/- 0.27 (mean +/- SD) to 0.64 +/- 0.26 (p less than 0.01) after bypass grafting, and this was most impressive in those eight patients with LAD lesions greater than 90% (0.32 +/- 0.20 before grafting to 0.60 +/- 0.29 after grafting, p less than 0.005). However, the epicardial ATP/TAN ratio decreased from 0.75 +/- 0.15 before grafting to 0.64 +/- 0.17 after grafting (p less than 0.05), and this decrease occurred regardless of the percent narrowing of the LAD. There was no difference in vacuolization between the pre-grafting and post-grafting biopsy specimens, and intramyocardial hemorrhage was not observed. This study has demonstrated a close relationship between the degree of LAD stenosis and endocardial ATP content. Also, the endocardium supplied by arteries with greater than 90% lesions had significantly increased ATP while the epicardium had decreased ATP content after bypass grafting.

Cardiac function in Duchenne's muscular dystrophy. Results of 10-year follow-up study and noninvasive tests.

The purposes of this study were to: (1) evaluate the progression of cardiac involvement in Duchenne's muscular dystrophy using systolic time intervals (PEP/LVET); (2) determine if the degree of cardiac involvement bears a relation to the severity of skeletal muscle disease; and (3) describe the M-mode and two-dimensional echocardiographic findings. In 1970, systolic time intervals were studied in 16 patients. During the 10-year interim, two patients were lost to follow-up study, and five patients died. Nine remaining patients were re-studied in 1980 with M-mode and two-dimensional echocardiography as well as systolic time intervals. The PEP/LVET value of these nine patients increased from 0.37 +/- 0.05 (mean +/- SD) in 1970 to 0.47 +/- 0.07 (p less than 0.005) in 1980. Three patients remained ambulatory, and their PEP/LVET value (0.41 +/- 0.04) was significantly better than that of the nonambulatory patients (0.50 +/- 0.07, p less than 0.05). The M-mode echocardiography percentage diameter change was also worse in the nonambulatory group (21 +/- 4 percent versus 34 +/- 7 percent, p less than 0.02). The five patients who were nonambulatory in 1970 died in the intervening 10 years. This study demonstrated that the heart disease of Duchenne's muscular dystrophy is progressive and that the severity of skeletal muscle disease is probably associated with the degree of cardiac dysfunction.