Ovarioscopy and laparoscopic removal of a large right adnexal cyst.

The combination of ovarioscopy and laparoscopy can be used to remove a large adnexal cyst.

Comparison of functional and radiological outcomes after computer-assisted versus conventional total knee arthroplasty: a matched-control retrospective study.

PURPOSE: To compare the radiological and functional outcomes of patients who underwent either computer-assisted or conventional total knee arthroplasty (TKA). METHODS: Two groups of 50 patients each underwent either computer-assisted or conventional TKA were retrospectively studied. Patients were matched according to body mass index (BMI), gender, and age. Three senior orthopaedic surgeons with comparable experience performed all surgeries, using 3 different prostheses. The surgical approach and peri- and postoperative regimens were the same. The mechanical axis and the tibial and femoral angles were measured using standardised long-leg weight-bearing radiographs. Overall function was assessed using the Short Form-12 (SF-12) and International Knee Society (IKS) scores. RESULTS: No intra-operative technical difficulties were encountered in either group. The computer-assisted group resulted in more consistent and accurate alignments in both the coronal and sagittal planes and better SF-12 and IKS scores. In obese patients (BMI=30 kg/m2 or more), computer-assisted TKA provided better alignment than the conventional technique. CONCLUSION: Computer-assisted TKA improves implant positioning, limb alignment, and overall functional outcome. It may be particularly advantageous for obese patients.

Dermal hypoesthesia after total knee arthroplasty.

Dermal hypoesthesia is a well-recognized sequelae of total knee arthroplasty (TKA). However, it is poorly documented. Thirty-five knees were evaluated for hypoesthesia among 26 patients after TKA to determine the incidence, area affected, and change over time in situ. All knees sustained an area of hypoesthesia, showing diminution over time. All were affected lateral to the medial parapatellar incision. A 71% decline of the area affected was seen over the first 2 years after surgery. All patients had some residual hypoesthesia with a mean of 33 cm2 at 2 years.

Differences in impulse distribution in patients with plantar fasciitis.

The impulse distribution based upon vertical foot-floor reaction forces and time under the fore-, mid-, and hindfoot was determined using Tekscan's F-Scan system. This was compared in 40 barefoot patients with long-standing plantar fasciitis with an equal number of normal subjects. The patient group tended to load the hind- and midfoot to a lesser extent than the control group. Consequently, a greater proportionate load was borne by the forefoot. This result was highly significant for both the midfoot (P < 0.001) and forefoot (P = 0.002) comparisons. An objective biomechanical method such as this may be useful as a diagnostic aid, to identify individuals predisposed to this condition, and for evaluating the efficacy of various treatment modalities.

No scalpel, no iv, no stitch, microendoscopic office laparoscopy under local anesthesia.

BACKGROUND: The medical literature is replete with articles verifying the usefulness of laparoscopic procedures under local anesthesia. Recent research has examined the efficacy of microendoscopy with local anesthesia. In this series of patients, we focused on new technology to determine if microendoscopy could be utilized in an office setting. METHODS: Between July 1994 and April 1995, we performed 51 microendoscopic office laparoscopy under local anesthesia (MICRO-OLULA) using the 1.5 mm Pixie laparoscope by Origin, a 1.7 mm laparoscope by Optimed and 5 mm laparoscope by Jarit. All cases were performed in an office operating room at the Women's Medical Plaza in Montgomery, Alabama. Only one patient was unable to have the procedure completed due to intolerance under local anesthesia. RESULTS: Fifty-one micro-olulas were performed on these patients who had an average age of 31 years and an average weight of 157 pounds. Intraoperative abdominal time averaged 3 minutes. One case was done with a 5 mm laparoscope and five cases with the 1.7 mm Optimed laparoscope. The 1.5 mm Pixie laparoscope was used in 45 patients. CONCLUSIONS: Our patients seemed to like the idea of a small device to view their pelvic cavities. The small laparoscopes provide excellent cosmesis, and laparoscopes deserve further development and clinical trial to determine their most advantageous use in the office setting.

Low-cost office laparoscopic sterilization.

Between September 1986 and February 1992 we performed 210 laparoscopic tubal ligations in our office under local anesthesia using the Hulka clip. During the last 2 years we used a microchip video camera and endocoagulated the fallopian tubes adjacent to the clip in 84 women. The length of time for each procedure ranged from 15 to 30 minutes (average 20 min). There were no intraoperative complications. Failure to tolerate abdominal lifting (the "belly" test) was the only contraindication in this series. Previous abdominal surgery was not a contraindication. The three known failures in our first 69 cases were thought to be inaccurate clip applications. Subsequently, we added endocoagulation to the technique. Our procedure is cost efficient and time saving for both patients and physicians.

A long-term review of shelf arthroplasty.

Shelf arthroplasty is briefly reviewed in historical perspective and the results in 45 hips (39 patients) which had undergone this procedure at the Royal Children's Hospital are presented. The majority of these patients were adolescents who had previously been treated for congenital dislocation or subluxation of the hip. The indications for operation and the operative technique are discussed. Clinical examination was carried out upon 33 of the 39 patients at an average of 11 years after operation. The results suggested that where pain had been an indication for operation almost 80 percent of the hips remained relatively free of symptoms at the time of follow-up and in those patients where acetabular dysplasia had been an indication, the coverage remained good and pain had not appeared. It is concluded that the shelf operation is useful for dealing with both pain and dysplasia in the adolescent.

Femoral nerve block: a simple and safe method of instant analgesia for femoral shaft fractures in children.

A simple safe technique of providing rapid, effective analgesia in children with femoral shaft fractures is described. It is particularly useful in patients who have associated head or abdominal injuries in the presence of which opiates should be withheld. The technique is recommended to all practitioners involved in the early care of femoral shaft fractures.

The tourniquet.

The morbidity of the tourniquet is not well documented. The "post-tourniquet syndrome" is the most common side effect, but is usually unrecognized. The causation of nerve palsy, although this sequela is uncommon, has been documented. Other problems associated with tourniquet use are discussed.

A recent development in the treatment of severe compound fractures.

The Wagner leg lengthening device has recently been used successfully as an external fixation device in the stabilization of severe compound fractures. Fixation is rigid, yet adjustable, it does not interfere with the fracture site, and it allows clear access to wounds.