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Incision
Kinds of Incision Terms modified by Incision Selected AbstractsMINI-FLANK SUPRA-11TH RIB INCISION FOR OPEN PARTIAL OR RADICAL NEPHRECTOMYBJU INTERNATIONAL, Issue 3 2006ABHAY RANÉ No abstract is available for this article. [source] Developing a post-fire flood chronology and recurrence probability from alluvial stratigraphy in the Buffalo Creek watershed, Colorado, USA,HYDROLOGICAL PROCESSES, Issue 15 2001John G. Elliott Abstract Stratigraphic and geomorphic evidence indicate floods that occur soon after forest fires have been intermittent but common events in many mountainous areas during the past several thousand years. The magnitude and recurrence of these post-fire flood events reflects the joint probability between the recurrence of fires and the recurrence of subsequent rainfall events of varying magnitude and intensity. Following the May 1996 Buffalo Creek, Colorado, forest fire, precipitation amounts and intensities that generated very little surface runoff outside of the burned area resulted in severe hillslope erosion, floods, and streambed sediment entrainment in the rugged, severely burned, 48 km2 area. These floods added sediment to many existing alluvial fans, while simultaneously incising other fans and alluvial deposits. Incision of older fans revealed multiple sequences of fluvially transported sandy gravel that grade upward into charcoal-rich, loamy horizons. We interpret these sequences to represent periods of high sediment transport and aggradation during floods, followed by intervals of quiescence and relative stability in the watershed until a subsequent fire occurred. An alluvial sequence near the mouth of a tributary draining a 0·82 km2 area indicated several previous post-fire flood cycles in the watershed. Dendrochronologic and radiocarbon ages of material in this deposit span approximately 2900 years, and define three aggradational periods. The three general aggradational periods are separated by intervals of approximately nine to ten centuries and reflect a ,millennium-scale' geomorphic response to a closely timed sequence of events: severe and intense, watershed-scale, stand-replacing fires and subsequent rainstorms and flooding. Millennium-scale aggradational units at the study site may have resulted from a scenario in which the initial runoff from the burned watershed transported and deposited large volumes of sediment on downstream alluvial surfaces and tributary fans. Subsequent storm runoff may have produced localized incision and channelization, preventing additional vertical aggradation on the sampled alluvial deposit for several centuries. Two of the millennium-scale aggradational periods at the study site consist of multiple gravel and loam sequences with similar radiocarbon ages. These closely dated sequences may reflect a ,multidecade-scale' geomorphic response to more frequent, but aerially limited and less severe fires, followed by rainstorms of relatively common recurrence. Published in 2001 John Wiley & Sons, Ltd. [source] Incision and Drainage of a Retropharyngeal Abscess Located Adjacent to C1 with InstaTrak Image Guidance,THE LARYNGOSCOPE, Issue 3 2006Amar C. Suryadevara MD No abstract is available for this article. [source] Retroauricular Hairline Incision for Removal of Upper Neck MassesTHE LARYNGOSCOPE, Issue 12 2005Jong-Lyel Roh MD Abstract Background/Objectives: The general population has been increasingly concerned about cosmesis and hopeless about prominent or invisible postoperative scars of the face and neck. The purpose of this study was to evaluate the benefit of a retroauricular hairline incision (RAHI) by comparing it with conventional cervical incision for removal of upper neck masses. Study Design: Prospective clinical study. Methods: Thirty-four patients with upper neck masses were divided into two surgical groups of RAHI (17) and conventional cervical incision (17) matched by age, sex, marital status and size, location, pathology of lesions. The operation time, complications, length of hospital stay, and subjective satisfaction with incision scar checked by visual analogue scale were compared between groups. Results: The lesions of each group were congenital cysts (6), abscesses (2), inflammatory masses (2), and benign (6) or malignant (1) tumors and located in the upper neck. Mean operation time was 51 ± 17 minute in the RAHI group and 41 ± 13 minutes in the controls (P = .064). Mean hospital stay and complication rates were comparable between groups. Mean score of patient's satisfaction was 8.9 ± 0.7 in the RAHI group and 4.5 ± 2.7 in the controls (P < .001). The degree of incision scarring did not differ between groups, but the scars were less visible in the RAHI group because of hiding by the auricle and hair. Conclusions: The postauricular approach leading to a potentially invisible area of operation has a clear cosmetic benefit compared with conventional cervical incision. This will be helpful for patients with surgically indicated upper neck masses who hope for invisible incision scars. [source] The Use of Bivalirudin for Cardiopulmonary Bypass Anticoagulation in Pediatric Heparin-Induced Thrombocytopenia PatientsARTIFICIAL ORGANS, Issue 8 2010Richard Gates Abstract Infants with heparin-induced thrombocytopenia (HIT) represent a challenging and high-risk group of patients when they require cardiopulmonary bypass (CPB). Bivalirudin offers many potential pharmacologic advantages over other nonheparin anticoagulants for such patients. We describe our protocol for the use of bivalirudin in a 5-month-old infant undergoing stage 2 Norwood for hypoplastic left heart syndrome. The patient was a 5- month-old, 6-kg infant who developed HIT after a bowel resection complicating initial Norwood stage 1. After sternotomy and dissection had been redone, the child received an initial dose of bivalirudin of 1.0 mg/kg and 0.5 mg/kg 5 min later. The CPB circuit was primed with 50 mg/kg bivalirudn/400 cc volume. With the initiation of CPB, a continuous infusion of 2.5 mg/kg bivalirudin was begun. Activated clotting time (ACT) was targeted for over 400 s, with an examination prior to bypass and each 15 min thereafter. Bivalirudin was discontinued with separation from bypass and during modified ultrafiltration (MUF). The ACT was 286 s after the initial 1 mg/kg bolus and 597 s after the second 0.5 mg/kg bolus and initiation of CPB. At a rate of 2.5 mg/kg/min, ACT ranged between 461 and 597 s. At the completion of MUF, the ACT was 316 s. The ACT was 214 s 20 min after MUF. No clots were noted in the CPB circuit, and good hemostasis was achieved within 10 min after MUF was completed. Incision to closure time was 160 min; time from completion of MUF to sternal closure was 30 min. Post-MUF, 60 cc of processed cell saver blood was reinfused, and no clotting factors were required. Chest tube output was 10, 10, 3, and 4 ccs, respectively, at hours 1,4 post operation. Bivalirudin provides effective anticoagulation in infants requiring CPB in the presence of HIT. Bivalirudin's efficacy is effectively monitored by ACT, and, after CPB, its short half-life and ability to be ultrafiltered facilitate the ability to achieve hemostasis in a timely fashion. [source] Skin Abscess Model for Incision and DrainageACADEMIC EMERGENCY MEDICINE, Issue 2009Myto Duong Background: Skin and soft tissue infection diagnosis is increasing dramatically across the nation. All healthcare providers need to be trained in adequate incision and drainage of these lesions. The only descriptions of skin and soft tissue models in the literature involve the use of cadavers or chickens. We devised an inexpensive and easily assembled skin abscess model that will be invaluable for the training of this procedure for all healthcare providers. This relatively realistic skin abscess model can be assembled within minutes using materials that can be purchased in your local grocery or home improvement store. The steps required in the creation of this abscess model will be depicted in the exhibit. Supplies for assembly of the model will be available during the exhibition for participants to build their own abscess and practice incising and draining their abscess. Materials: ? Lotion (white) mixed with food coloring (red, blue, yellow) ? Baby oil gel ? 1" Urethane Foam sheeting ? Heavy cardboard or poster board ? Food handler gloves (Textra Cast Poly) ? Glue gun (low temp) ? Low temp glue gun sticks ?"Smooth Top® Easy Liner®" shelf liner ? Abscess incision and drainage kit. Conclusion: This exhibit will provide a detailed description of how to assemble a quick and easy skin abscess model for incision and drainage. This model can be used in the skills lab to demonstrate and practice this basic procedure. [source] Endoscopic sphenopalatine artery ligation , when, why and how to do it.CLINICAL OTOLARYNGOLOGY, Issue 6 2005An on-line video tutorial Keypoints ,,Endoscopic ligation of the sphenopalatine artery (ESPAL) has recently become the treatment of choice for refractory epistaxis. This paper reviews the background, indications and potential complications of ESPAL. ,,The main focus of this article is an online video tutorial on the anatomy and surgical technique of ESPAL. Web links lead to video clips of operative steps and therefore this paper should be read in front of a computer with access to the internet. ,,To study the techniques the links detailed below should be followed. (For computers running realplayer software the .wmv extension in each of these links should be replaced with the .rm extension.) ,,Incision, http://www.nhsgg.org.uk/content/streams/Figure3.wmv ,,Flap elevation, http://www.nhsgg.org.uk/content/streams/Figure4.wmv ,,Pedicle location, http://www.nhsgg.org.uk/content/streams/Figure5.wmv ,,Clip application, http://www.nhsgg.org.uk/content/streams/Figure6.wmv [source] Effect of ,-trinositol on secretion induced by Escherichia coli ST-toxin in rat jejunumACTA PHYSIOLOGICA, Issue 4 2003A.-M. Lahti Abstract Aim:,d -myo-inositol-1,2,6-trisphosphate (, -trinositol, PP56), is a synthetic isomer of the intracellular second messenger, d -myo-inositol-1,4,5-trisphospahate. The pharmacological actions of , -trinositol include potent anti-inflammatory properties and inhibition of the secretion induced by cholera toxin and obstructive ileus. In the present study, we investigated whether , -trinositol was able to influence the secretion induced by heat-stable ST-toxin from Escherichia coli in the rat jejunum. Methods:, A midline abdominal incision was performed in anaesthetized male Sprague,Dawley rats and a 6,7 cm long jejunal segment was isolated with intact vascular supply and placed in a chamber suspended from a force displacement transducer connected to a Grass® polygraph. Intestinal net fluid transport was continuously monitored gravimetrically. Crystalline ST-toxin (120 mouse units) was introduced into the intestinal lumen and left there for the rest of the experiment. When a stable secretion was observed, , -trinositol (60 mg kg,1 h,1) or saline were infused during 2 h, followed by a 2-h control period. Results:, , -Trinositol induced a significant (P < 0.001) inhibition of ST-toxin secretion within 30 min, lasting until 2 h after infusion had stopped. The agent also moderately increased (P < 0.05) net fluid absorption in normal jejunum. Mean arterial pressure (P < 0.001) and heart rate (P < 0.001) were reduced by , -trinositol. Conclusion:, The inhibition by , -trinositol of ST-toxin induced intestinal secretion is primarily secondary to inhibition of secretory mechanisms and only to lesser extent due to increased absorption. The detailed mechanisms of action have not been clarified but may involve suppression of inflammation possibly by means of cellular signal transduction. [source] Biocompatibility evaluation of alendronate paste in rat's subcutaneous tissueDENTAL TRAUMATOLOGY, Issue 2 2009Graziela Garrido Mori Therefore, this study aimed to investigate the biocompatibility of experimental alendronate paste in subcutaneous tissue of rats, for utilization in teeth susceptible to root resorption. The study was conducted on 15 male rats, weighing ,180,200 grams. The rats' dorsal regions were submitted to one incision on the median region and, laterally to the incision, the subcutaneous tissue was raised and gently dissected for introduction of two tubes, in each rat. The tubes were sealed at one end with gutta-percha and taken as control. The tubes were filled with experimental alendronate paste. The animals were killed at 7, 15 and 45 days after surgery and the specimens were processed in laboratory. The histological sections were stained with hematoxylin-eosin and analyzed by light microscopy. Scores were assigned to the inflammatory process and statistically compared by the Tukey test (P < 0.05). Alendronate paste promoted severe inflammation process at 7 days, with statistically significant difference compared to the control (P < 0.05%). However, at 15 days, there was a regression of inflammation and the presence of connective tissue with collagen fibers, fibroblasts and blood vessels was observed. After 45 days, it was observed the presence of well-organized connective tissue, with collagen fibers and fibroblasts, and few inflammatory cells. No statistical difference was observed between the control and experimental paste at 15 and 45 days. The experimental alendronate paste was considered biocompatible with subcutaneous tissue of rat. [source] Reattachment of subgingivally fractured central incisor with an open apexDENTAL TRAUMATOLOGY, Issue 3 2007Ece Eden Abstract,,, A case report of a 6-year-old girl with a fractured maxillary left central incisor with an open apex is presented. The procedure used to repair the fracture included flap surgery with an intrasulcular incision and endodontic treatment. The patient was called for 3 months regular follow-up to check the root formation. At the end of 32 months just before the root was obturated by guttaperka, she fractured the same tooth. Flap surgery was repeated and the tooth was restored. The root canal was obturated with a root filling paste and guttaperka as the apex was closed. Examination 10 months after treatment revealed good periodontal health, aesthetics and normal function. [source] A Refined Surgical Treatment Modality for Bromhidrosis: Double W Incision Approach with Tumescent TechniqueDERMATOLOGIC SURGERY, Issue 8 2009HANG LI PHD BACKGROUND Axillary bromhidrosis has a strong negative effect on one's social life. A high success rate and few complications are criteria for an ideal treatment method. OBJECTIVE To evaluate a new surgical treatment modality for bromhidrosis: Double W incision with full-exposure excision under tumescent anesthesia. MATERIALS & METHODS Twenty patients with bromhidrosis were treated. Patients were placed in a supine position with their treated arms abducted to 110°. After injection of 60 mL of tumescent solution into each axilla, two small W incisions were made at the superior and inferior axillary poles of the hair-bearing area. The whole hair-bearing skin was undermined at the level of the superficial fat to obtain adequate skin eversion. The flaps were everted to offer full exposure of the apocrine glands, and meticulous excision of each gland was performed. Finally, the incisions were re-approximated, and bulky compressive dressings were applied to the area for 72 hours. RESULTS Of the 40 axillae (20 patients), 32 (80.0%) showed excellent results, and eight (20.0%) had good results. Malodor was significantly decreased. There were no serious complications. CONCLUSION This technique can produce excellent results with a lower complication rate than most other surgical modalities and can be performed without costly equipment. [source] Novel Face-Lift Suspension Suture and Inserting Instrument: Use of Large Anchors Knotted into a Suture with Attached Needle and Inserting Device Allowing for Single Entry Point Placement of Suspension Suture.DERMATOLOGIC SURGERY, Issue 3 2006Preliminary Report of 20 Cases with 6- to 12-Month Follow-Up BACKGROUND Various suspension suture techniques exist to elevate the mid-face, jowls, and neck. OBJECTIVE To assess safety and efficacy of a new suspension suture and inserting instrument with both standard and minimal incision (no-skin-excision) face-lifts. METHODS A new type of multianchor suspension suture assembled from commercially available 2-0 absorbable monofilament material, with 5 to 9 equally spaced knots through which are secured 7 to 9 mm bits of 0 thickness similar suture material, and an attached straightened needle, was used to elevate and suspend facial tissues to temporal or mastoid fascia. The suspension sutures are placed in the deep subcutaneous tissues, just above the superficial musculo aponeurotic system (SMAS), by use of a novel, blunt instrument, which does not require a second, distal exit point. The suspension suture distal end floats free. The proximal needle end is sutured to fascia. The suture was used on 20 patients. Fourteen of them underwent pure, "no-skin-excision," suspension lifts. Six had suspension suture elevation of the mid-face in conjunction with relatively conservative open lifts. Nine- to 12-month results were evaluated. RESULTS With open face-lifts, 9- to 12-month results are excellent with significant persistence of the correction initially achieved. Resulting scars remained fine line. There were no complications. With pure suspension lifts, initial results were impressive. By 6 months, correction started to fade. By 12 months 100% of initial correction for jowls, and 80 to 100% for mid-face, appeared lost. Recovery time was 2 to 4 days. There were no significant complications. CONCLUSION Large multianchor, absorbable monofilament sutures can safely and effectively enhance results of conservative lifts, with remarkable elevation of the mid-face not achievable with simple SMAS flaps. These suspension sutures can easily and safely achieve impressive, though relatively short-term results, with a minimal incision, "no-skin-excision" technique. [source] Intraoral Extraction of Cheek Skin CystDERMATOLOGIC SURGERY, Issue 12 2005Richard Bennett MD Background. When a physician encounters a benign subcutaneous cyst in the cheek, his or her decision whether to excise and how to excise the cyst takes into account the potential risk of postsurgical scarring. Objective. To describe and show an intraoral buccal mucosal approach to excising a cyst in the inferior-anterior cheek so that skin scarring is avoided. Method. An incision was made intraorally in the buccal mucosa, and dissection was carried through the buccinator muscle until the cyst wall was seen. Careful separation of tissue around the cyst was done by blunt dissection, and the unruptured cyst was removed through the buccal mucosal incision. Result. The entire intact cyst was removed without creating any excision marks in the cheek skin. No complications were encountered, and buccal mucosal healing was excellent. Conclusion. A buccal mucosal intraoral approach is an alternative to a percutaneous excision to remove a cyst in the lower cheek region. The intraoral approach avoids a visible scar on the cheek skin. RICHARD BENNETT, MD, MUBA TAHER, MD, AND JUSTINE YUN, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Minimal-Scar Segmental Extraction of Lipomas: Study of 122 Consecutive ProceduresDERMATOLOGIC SURGERY, Issue 1 2005Rajiv Y. Chandawarkar MD Background Surgical extirpation of lipomas that occur in cosmetically conspicuous areas of the body leaves a visible scar that is usually disfiguring. Minimal-scar segmental extraction (MSE) employs a much smaller incision and extraction and is particularly useful in exposed parts of the body. It can be easily performed in an office setting. Objective The objective of this study was to evaluate the merits of MSE in clinical practice. Unlike other reports in the literature that describe, anecdotally, minimally invasive methods of lipoma removal, our study examined a new method by carefully measuring the results in a larger group of consecutive patients treated using this technique. Materials and Methods A retrospective study was performed using data from 91 consecutive patients with a total of 122 lipomas that were treated using MSE. MSE of lipomas consists of a small stab incision and blind dissection of the tumor followed by its extraction in a segmental fashion. This procedure involves small instrumentation, minimal dissection with preservation of contour, and complete removal of the lipoma, including substantial portions of the capsule. Clinical data, including complications, outcomes, and recurrence rates, were recorded. Results The procedure was well tolerated by patients, who were pleased with the results, particularly the small scar. The incidence of complications was 1.6% (n= 2) and consisted of hematoma (n= 1) and seroma (n= 1). The recurrence rate was 0.8% (n= 1). No long-term morbidity was noted. Conclusions The technical ease with which the MSE can be performed, coupled with a low recurrence rate, makes it a very cost-effective operation. The smaller postoperative scars, rapid healing, and low morbidity allow for better patient acceptance. We recognize the advantages and limitations of this procedure and encourage its use in selected patients. RAJIV Y. CHANDAWARKAR, MD, PEDRO RODRIGUEZ, MD, JOHN ROUSSALIS, MD, AND M. DEVIPRASAD TANTRI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Efficacy of the Flashlamp-Pumped Pulsed-Dye Laser in Nonsurgical Delay of Skin FlapsDERMATOLOGIC SURGERY, Issue 7 2003Ali Riza Erçöçen MD Objective. The purpose of this article was to determine the effectiveness of laser delay by use of the flashlamp-pumped pulsed-dye laser operating at a wavelength of 585 nm; to elucidate the comparable or dissimilar macroscopic, microscopic, and hemodynamic changes between laser and surgical delay methods; and to clarify the possible mechanisms underlying the delay effect of laser. Methods. A standardized caudally based random dorsal rat flap model was used in this study: Acute random skin flaps served as control subjects (group 1). Surgical delay was employed by incision of lateral longitudinal borders both without (group 2) and with (group 3) undermining, and laser delay methods were performed by laser irradiation of both lateral longitudinal borders (group 4) and the entire surface (group 5) of the proposed flap. Evaluation was done by histologic examination, India ink injection, laser Doppler perfusion imaging, and measurement of flap survival. Results. Histologically, dilation and hypertrophy of subpapillary and subdermal vessels were evident in groups 2, 3, and 4; on the other hand, degranulation of mast cells in the vicinity of occluded vessels at the 1st hour of laser delay and a striking mast cell proliferation and degranulation in association with newly formed vessels (angiogenesis) at the 14th day of laser delay were prominent in group 5. India ink injections revealed longitudinally arranged large-caliber vessels and cross-filling between the vessels of adjacent territories in groups, 2, 3, and 4, but only small-caliber vessels in group 5. Compared with the acute flaps, both surgical and laser delay significantly increased the mean flap perfusion to the maximal levels after a 14-day delay period, and all delay procedures improved flap survival; the most significant increase in surviving area was observed in group 3, whereas the less significant increase in surviving area was in group 5. Conclusion. This study demonstrates that laser delay is as effective as surgical delay and that laser delay by lasering lateral borders leads to dilation and longitudinal rearrangement of the existing vessels rather than angiogenesis, whereas laser delay by lasering the entire surface results in delay effect by inducing angiogenesis due to activation and degranulation of the mast cells. [source] Follicular Unit Extraction: Minimally Invasive Surgery for Hair TransplantationDERMATOLOGIC SURGERY, Issue 8 2002William R. Rassman MD background. Follicular Unit Transplantation (FUT) is performed using large numbers of naturally occuring individual follicular units obtained by single-strip harvesting and stereo-microscopic dissection. Donor wound scarring from strip excision, although an infrequent complication, still concerns enough patients that an alternative solution is warranted. objective. The purpose of this paper is to introduce Follicular Unit Extraction (The FOX Procedure), in which individual follicular units are removed directly from the donor region through very small punch excisions, and to describe a test (The FOX Test) that determines which patients are candidates for this procedure. This paper explores the nuances, limitations, and practical aspects of Follicular Unit Extraction (FUE). methods. FUE was performed using 1-mm punches to separate follicular units from the surrounding tissue down to the level of the mid dermis. This was followed by extraction of the follicular units with forceps. The FOX test was developed to determine which patients would be good candidates for the procedure. The test was performed on 200 patients. Representative patients who were FOX-positive and FOX-negative were studied histologically. results. The FOX Test can determine which patients are suitable candidates for FUE. Approximately 25% of the patients biopsied were ideal candidates for FUE and 35% of the patients biopsied were good candidates for extraction. conclusion. FUE is a minimally invasive approach to hair transplantation that obviates the need for a linear donor incision. This technique can serve as an important alternative to traditional hair transplantation in certain patients. [source] The Surgical Looking Glass: A Readily Available Safeguard Against Eye Splash Injury/Contamination During Infiltration of Anesthesia for Cysts and Other "Porous" Lesions of the SkinDERMATOLOGIC SURGERY, Issue 4 2002Patrick R. Carrington MD Background. "Breaks" in barrier precautions are a definite abrogating influence on the effectiveness of "universal precautions." Dermatologists and dermatologic surgeons are exposed to significant infectious agents on a daily basis, especially due to the high number of minor surgical procedures performed. Backsplash, spray, and eye splash of bodily fluids during these procedures place the surgeon at a high risk of contamination/infection via the conjunctival membranes. The surgical looking glass is a simple utility based on inexpensive equipment already in place in the physician's office which protects the eyes and face during infiltrative anesthesia or incision of cysts and other lesions. Objective. To offer a simple and inexpensive utility to assist with protection from and reduction of contamination/infection of the ocular mucous membranes during surgical procedures. Methods. Utilizing one or two readily available microscope slides overlying the injection site during local infiltrative anesthesia, backsplash or spray can be contained. Results. This utility is effective in containment of backsplash or spray of anesthesia or bodily fluids during even minor surgical procedures. Conclusion. The surgical looking glass can enhance safety and promote "universal precautions" during even minor surgical procedures or infiltration of anesthesia into more porous areas or lesions for the practicing dermatologist or dermatologic surgeon. The pragmatic, practical, and inexpensive nature of the surgical looking glass invites its use on a daily basis by the practicing dermatologist. [source] An Alternate Approach for Harvesting Mohs Specimens with a Flexible ScalpelDERMATOLOGIC SURGERY, Issue 10 2001Andrew T. Jaffe MD Background. Mohs micrographic surgery is a highly successful technique for removing skin cancers while conserving normal tissue. However, conservation of the deep margins can often be difficult to achieve when using a standard scalpel. An inability to conserve normal tissue at the deep margins can greatly impact the complexity of repair, duration of surgery, aesthetic result, and patient morbidity. Objective. To find an alternative method of obtaining Mohs specimens that offers greater control of the depth of incision when compared to the standard scalpel. Methods. We utilized a flexible scalpel to obtain Mohs levels on patients with superficial cutaneous malignancies in anatomic locations where careful conservation of the deep margins would allow for less extensive repair. Results. For those patients who had tumor-free margins after one level of Mohs surgery, the shallower defects achieved with the flexible scalpel allowed for excellent cosmetic outcomes and decreased patient operative time and morbidity. Conclusion. The flexible scalpel is both effective and efficient in obtaining thin Mohs specimens when conservation of the deep margin is of utmost importance. [source] Liposuction of Neck and Jowls: Five-Incision Method Combining Machine-Assisted and Syringe AspirationDERMATOLOGIC SURGERY, Issue 4 2000Robert C. Langdon MDArticle first published online: 24 DEC 200 Background. Liposuction of the jowl region is difficult from a single submental incision and must be done conservatively in order to avoid overresection of fat. The neck region may be suctioned much more completely. Objective. A new method for liposuction of the neck and jowls that uses five incisions and that combines syringe suctioning of the jowls and machine-assisted suctioning of the neck has been developed. Methods. The neck was suctioned from submental and infra-auricular incisions. The jowls were suctioned from the infra-auricular and additional infrajowl incisions. Results. This method has been used on 68 patients over a 3-year period. Three additional patients underwent syringe liposuction of only the jowls. Volumes of fat aspirated from bilateral jowls were consistently nearly equal. The incidence of adverse events was low. Conclusion. This method enables conservative removal of jowl fat and thorough removal of neck fat, with a low incidence of adverse sequalae. [source] Cytology of the central zone of the prostateDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2003Lars Egevad M.D., Ph.D. Abstract The prostate has three anatomical regions: the peripheral, transition, and central zones (CZ). The CZ has distinct histological features, but its cytological morphology has not been described. This study was done on surgical specimens to ensure that samples were representative of the CZ, and that no prostatic intraepithelial neoplasia (PIN) or cancer contaminated the smears. An incision was made in the CZ of 51 prostatectomy specimens, and cells were scraped from cut surfaces. After exclusion of samples contaminated by PIN or cancer or with poor cell yield, 39 Giemsa-stained smears remained for analysis. Large branching epithelial sheets with geographic architecture and crowded nuclei were seen in 97% of smears. Epithelial clusters with elongated palisaded nuclei were identified in 80% of cases, but were always a minor component. Visible nucleoli (97%), cytoplasmic vacuoles (97%), and smooth muscle cells in the background (95%) were common. Blue-green cytoplasmic granules resembling seminal vesicle pigment were seen in 97%. Magenta-colored cytoplasmic pigment, similar to granules seen in other regions of the prostate, was found in 74%. Recognition of CZ epithelium as a benign constituent of prostate cytology is important because elongated cells, crowded nuclei, and visible nucleoli may otherwise be misinterpreted as PIN or cancer. Diagn. Cytopathol. 2003;28:239,244. © 2003 Wiley-Liss, Inc. [source] THERAPEUTIC FISTULOSCOPY FOR THE MANAGEMENT OF PROLONGED POSTOPERATIVE INTRA-ABDOMINAL ABSCESS CAUSED BY SMALL INTESTINAL PINHOLE PERFORATIONDIGESTIVE ENDOSCOPY, Issue 4 2005Yoshihisa Saida Fistuloscopy is an effective treatment for intractable fistula, a sometimes difficult to manage postoperative intra-abdominal complication. A case of a 69-year-old male with an abdominal abscess after he underwent right hemi-colectomy for cecum cancer with invasions into the ileum and sigmoid colon is reported. A re-operation for lavage and drainage was performed 2 weeks after surgery. However, no obvious origin for the pus was located. Although physiological saline lavage was repeatedly performed, the effusion of pus persisted in the drain at the midline incision about 7 months after surgery. Then, fistuloscopy with an upper gastrointestinal endoscope was performed through the hole of the tube. A pinhole that produced a bubble just below the midline incision was observed. Then, an endoscopic retrograde cholangiopancreatography (ERCP) tube was inserted to obtain images of the small intestine by fluorography and findings suggested a diagnosis of perforation of the small intestine, which appeared to explain why resolution of the abscess was prolonged. After direct drainage to the small intestine with a 40-cm-long 7 Fr percutaneous transhepatic cholangio drainage (PTCD) balloon catheter, pus from the tube notably decreased. After confirming that the abscess cavity had disappeared by abdominal computed tomography scan, the PTCD catheter was extracted about 8 months after primary surgery. Since then, no recurrence of cancer or abscess has been observed. In cases of intractable postoperative intra-abdominal abscess, fistuloscopy using smaller diameter gastrointestinal endoscopy appears to be a valuable diagnostic tool. [source] Slope development reconstruction at two sites in the Bohemian Forest MountainsEARTH SURFACE PROCESSES AND LANDFORMS, Issue 4 2010Filip Hartvich Abstract Although the Bohemian Forest is generally considered to be geomorphologically a rather stable region, there are localities which bear proof of a surprisingly high intensity of recent and even present day processes. A multidisciplinary methodology based on the analysis of slope systems was used for researching the present and past dynamics of two hillslopes. Using the results of direct dilatometric monitoring (the slow creep of rock blocks reached a maximum of 1,mm year,1), GPS field mapping, sedimentology, geodetic measurements and DEM analyses, several common rules have been observed for the behaviour of two model localities and a likely polycyclic development established, with recurrence of mass-wasting cycles related to material supply thresholds. Radiometric dating of debris flow activity showed that the cycles span approximately 4000 years. In this area of rather stable bedrock conditions, at least two factors that decrease slope stability need to act together to activate slope processes: i.e. a favourable structural predisposition (dip of major joint or bedding planes) and an increase in relief through either glaciation or river incision. Copyright © 2010 John Wiley & Sons, Ltd. [source] Quantifying periglacial erosion: insights on a glacial sediment budget, Matanuska Glacier, AlaskaEARTH SURFACE PROCESSES AND LANDFORMS, Issue 15 2009Colin R. O'Farrell Abstract Glacial erosion rates are estimated to be among the highest in the world. Few studies have attempted, however, to quantify the flux of sediment from the periglacial landscape to a glacier. Here, erosion rates from the nonglacial landscape above the Matanuska Glacier, Alaska are presented and compare with an 8-yr record of proglacial suspended sediment yield. Non-glacial lowering rates range from 1·8 ± 0·5,mm,yr,1 to 8·5 ± 3·4,mm,yr,1 from estimates of rock fall and debris-flow fan volumes. An average erosion rate of 0·08 ± 0·04,mm,yr,1 from eight convex-up ridge crests was determined using in situ produced cosmogenic 10Be. Extrapolating these rates, based on landscape morphometry, to the Matanuska basin (58% ice-cover), it was found that nonglacial processes account for an annual sediment flux of 2·3 ± 1·0 × 106,t. Suspended sediment data for 8 years and an assumed bedload to estimate the annual sediment yield at the Matanuska terminus to be 2·9 ± 1·0 × 106,t, corresponding to an erosion rate of 1·8 ± 0·6,mm,yr,1: nonglacial sources therefore account for 80 ± 45% of the proglacial yield. A similar set of analyses were used for a small tributary sub-basin (32% ice-cover) to determine an erosion rate of 12·1 ± 6·9,mm,yr,1, based on proglacial sediment yield, with the nonglacial sediment flux equal to 10 ± 7% of the proglacial yield. It is suggested that erosion rates by nonglacial processes are similar to inferred subglacial rates, such that the ice-free regions of a glaciated landscape contribute significantly to the glacial sediment budget. The similar magnitude of nonglacial and glacial rates implies that partially glaciated landscapes will respond rapidly to changes in climate and base level through a rapid nonglacial response to glacially driven incision. Copyright © 2009 John Wiley & Sons, Ltd. [source] Amount and controls of the quaternary denudation in the Ardennes massif (western Europe)EARTH SURFACE PROCESSES AND LANDFORMS, Issue 11 2009A. Demoulin Abstract It is still debated whether the primary control on the middle Pleistocene denudation of the uplifted Ardennes massif (western Europe) is tectonic or climatic. Here, based on geomorphological observations, we calculate the amount of river incision and interfluve denudation in the Meuse basin upstream of Maastricht since 0·7 Ma and we show that the main response to tectonic forcing was incision. This allows us to provide first-order estimates of the tectonic and climatic contributions to the denudation of the Ardennes. From a dataset of 71 remnants of a terrace level dated ,0·7 Ma, we first derive a basin-scale functional relationship linking incision with distances to the regional base level (Lc) and to the source (Ls) in the Ourthe basin (pertaining to the Ardennian part of the Meuse basin). Expressed as I = I0*(1 , a*Lcb/Lsc), I0 being the incision measured at the basin outlet, this relationship calculates that river incision has removed 84 km3 of rock in the Meuse basin upstream of Maastricht since 0·7 Ma. In the same time, 292 km3 were eroded from the interfluves. A comparison of these volumes shows that the tectonically forced river incision accounts for ,22% of the total post-0·7 Ma denudation. Furthermore, the mean denudation rate corresponding to our geomorphological estimate of the overall denudation in the Meuse basin since 0·7 Ma amounts to 27 mm/ky, a figure significantly lower than the ,40 mm/ky mean rate derived from 10Be studies of terrace deposits of the Meuse (Schaller et al., 2004). This suggests that, taken as a basin average, the 10Be-derived rate is overestimated, probably due to an overrepresentation of the erosion products of the rapidly incising valleys in the alluvial deposits. Copyright © 2009 John Wiley & Sons, Ltd. [source] Flow energy and channel adjustments in rills developed in loamy sand and sandy loam soilsEARTH SURFACE PROCESSES AND LANDFORMS, Issue 1 2009Jovan R. Stefanovic Abstract The storms usually associated with rill development in nature are seldom prolonged, so development is often interrupted by interstorm disturbances, e.g. weathering or tillage. In laboratory simulated rainfall experiments, active rill development can be prolonged, and under these conditions typically passes through a period of intense incision, channel extension and bifurcation before reaching quasi-stable conditions in which little form change occurs. This paper presents laboratory experiments with coarse textured soils under simulated rainfall which show how channel adjustment processes contribute to the evolution of quasi-stability. Newly incised rills were stabilized for detailed study of links between rill configuration and flow energy. On a loamy sand, adjustment towards equilibrium occurred due to channel widening and meandering, whereas on a sandy loam, mobile knickpoints and chutes, pulsations in flow width and flow depth and changes in stream power and sediment discharge occurred as the channel adjusted towards equilibrium. The tendency of rill systems towards quasi-stability is shown by changes in stream power values which show short-lived minima. Differences in energy dissipation in stabilized rills indicate that minimization of energy dissipation was reached locally between knickpoints and at the downstream ends of rills. In the absence of energy gradients in knickpoints and chutes, stabilized rill sections tended toward equilibrium by establishing uniform energy expenditure. The study confirmed that energy dissipation increased with flow aspect ratio. In stabilized rills, flow acceleration reduced energy dissipation on the loamy sand but not on the sandy loam. On both soils flow deceleration tended to increase energy dissipation. Understanding how rill systems evolve towards stability is essential in order to predict how interruptions between storms may affect long-term rill dynamics. This is essential if event-based physical models are to become effective in predicting sediment transport on rilled hillslopes under changing weather and climatic conditions. Copyright © 2008 John Wiley and Sons, Ltd. [source] Modelling increased soil cohesion due to roots with EUROSEMEARTH SURFACE PROCESSES AND LANDFORMS, Issue 13 2008S. De Baets Abstract As organic root exudates cause soil particles to adhere firmly to root surfaces, roots significantly increase soil strength and therefore also increase the resistance of the topsoil to erosion by concentrated flow. This paper aims at contributing to a better prediction of the root effects on soil erosion rates in the EUROSEM model, as the input values accounting for roots, presented in the user manual, do not account for differences in root density or root architecture. Recent research indicates that small changes in root density or differences in root architecture considerably influence soil erosion rates during concentrated flow. The approach for incorporating the root effects into this model is based on a comparison of measured soil detachment rates for bare and for root-permeated topsoil samples with predicted erosion rates under the same flow conditions using the erosion equation of EUROSEM. Through backwards calculation, transport capacity efficiencies and corresponding soil cohesion values can be assessed for bare and root-permeated topsoils respectively. The results are promising and present soil cohesion values that are in accordance with reported values in the literature for the same soil type (silt loam). The results show that grass roots provide a larger increase in soil cohesion as compared with tap-rooted species and that the increase in soil cohesion is not significantly different under wet and dry soil conditions, either for fibrous root systems or for tap root systems. Power and exponential relationships are established between measured root density values and the corresponding calculated soil cohesion values, reflecting the effects of roots on the resistance of the topsoil to concentrated flow incision. These relationships enable one to incorporate the root effect into the soil erosion model EUROSEM, through adapting the soil cohesion input value. A scenario analysis shows that the contribution of roots to soil cohesion is very important for preventing soil loss and reducing runoff volume. The increase in soil shear strength due to the binding effect of roots on soil particles is two orders of magnitude lower as compared with soil reinforcement achieved when roots mobilize their tensile strength during soil shearing and root breakage. Copyright © 2008 John Wiley & Sons, Ltd. [source] Regional analysis of bedrock stream long profiles: evaluation of Hack's SL form, and formulation and assessment of an alternative (the DS form)EARTH SURFACE PROCESSES AND LANDFORMS, Issue 5 2007Geoff Goldrick Abstract The equilibrium form of the fluvial long profile has been used to elucidate a wide range of aspects of landscape history including tectonic activity in tectonic collision zones, and in continental margin and other intraplate settings, as well as other base-level changes such as due to sealevel fluctuations. The Hack SL form of the long profile, which describes a straight line on a log,normal plot of elevation (normal) versus distance (logarithmic), is the equilibrium long profile form that has been most widely used in such studies; slope,area analysis has also been used in recent years. We show that the SL form is a special case of a more general form of the equilibrium long profile (here called the DS form) that can be derived from the power relationship between stream discharge and downstream distance, and the dependence of stream incision on stream power. The DS form provides a better fit than the SL form to river long profiles in an intraplate setting in southeastern Australia experiencing low rates of denudation and mild surface uplift. We conclude that, if an a priori form of the long profile is to be used for investigations of regional landscape history, the DS form is preferable. In particular, the DS form in principle enables equilibrium steepening due to an increase in channel substrate lithological resistance (parallel shift in the DS plot) to be distinguished from disequilibrium steepening due to long profile rejuvenation (disordered outliers on the DS plot). Slope,area analysis and the slope,distance (DS) approach outlined here are complementary approaches, reflecting the close relationship between downstream distance and downstream catchment area. Copyright © 2006 John Wiley & Sons, Ltd. [source] Long-term landscape evolution: linking tectonics and surface processesEARTH SURFACE PROCESSES AND LANDFORMS, Issue 3 2007Paul Bishop Abstract Research in landscape evolution over millions to tens of millions of years slowed considerably in the mid-20th century, when Davisian and other approaches to geomorphology were replaced by functional, morphometric and ultimately process-based approaches. Hack's scheme of dynamic equilibrium in landscape evolution was perhaps the major theoretical contribution to long-term landscape evolution between the 1950s and about 1990, but it essentially ,looked back' to Davis for its springboard to a viewpoint contrary to that of Davis, as did less widely known schemes, such as Crickmay's hypothesis of unequal activity. Since about 1990, the field of long-term landscape evolution has blossomed again, stimulated by the plate tectonics revolution and its re-forging of the link between tectonics and topography, and by the development of numerical models that explore the links between tectonic processes and surface processes. This numerical modelling of landscape evolution has been built around formulation of bedrock river processes and slope processes, and has mostly focused on high-elevation passive continental margins and convergent zones; these models now routinely include flexural and denudational isostasy. Major breakthroughs in analytical and geochronological techniques have been of profound relevance to all of the above. Low-temperature thermochronology, and in particular apatite fission track analysis and (U,Th)/He analysis in apatite, have enabled rates of rock uplift and denudational exhumation from relatively shallow crustal depths (up to about 4 km) to be determined directly from, in effect, rock hand specimens. In a few situations, (U,Th)/He analysis has been used to determine the antiquity of major, long-wavelength topography. Cosmogenic isotope analysis has enabled the determination of the ,ages' of bedrock and sedimentary surfaces, and/or the rates of denudation of these surfaces. These latter advances represent in some ways a ,holy grail' in geomorphology in that they enable determination of ,dates and rates' of geomorphological processes directly from rock surfaces. The increasing availability of analytical techniques such as cosmogenic isotope analysis should mean that much larger data sets become possible and lead to more sophisticated analyses, such as probability density functions (PDFs) of cosmogenic ages and even of cosmogenic isotope concentrations (CICs). PDFs of isotope concentrations must be a function of catchment area geomorphology (including tectonics) and it is at least theoretically possible to infer aspects of source area geomorphology and geomorphological processes from PDFs of CICs in sediments (,detrital CICs'). Thus it may be possible to use PDFs of detrital CICs in basin sediments as a tool to infer aspects of the sediments' source area geomorphology and tectonics, complementing the standard sedimentological textural and compositional approaches to such issues. One of the most stimulating of recent conceptual advances has followed the considerations of the relationships between tectonics, climate and surface processes and especially the recognition of the importance of denudational isostasy in driving rock uplift (i.e. in driving tectonics and crustal processes). Attention has been focused very directly on surface processes and on the ways in which they may ,drive' rock uplift and thus even influence sub-surface crustal conditions, such as pressure and temperature. Consequently, the broader geoscience communities are looking to geomorphologists to provide more detailed information on rates and processes of bedrock channel incision, as well as on catchment responses to such bedrock channel processes. More sophisticated numerical models of processes in bedrock channels and on their flanking hillslopes are required. In current numerical models of long-term evolution of hillslopes and interfluves, for example, the simple dependency on slope of both the fluvial and hillslope components of these models means that a Davisian-type of landscape evolution characterized by slope lowering is inevitably ,confirmed' by the models. In numerical modelling, the next advances will require better parameterized algorithms for hillslope processes, and more sophisticated formulations of bedrock channel incision processes, incorporating, for example, the effects of sediment shielding of the bed. Such increasing sophistication must be matched by careful assessment and testing of model outputs using pre-established criteria and tests. Confirmation by these more sophisticated Davisian-type numerical models of slope lowering under conditions of tectonic stability (no active rock uplift), and of constant slope angle and steady-state landscape under conditions of ongoing rock uplift, will indicate that the Davis and Hack models are not mutually exclusive. A Hack-type model (or a variant of it, incorporating slope adjustment to rock strength rather than to regolith strength) will apply to active settings where there is sufficient stream power and/or sediment flux for channels to incise at the rate of rock uplift. Post-orogenic settings of decreased (or zero) active rock uplift would be characterized by a Davisian scheme of declining slope angles and non-steady-state (or transient) landscapes. Such post-orogenic landscapes deserve much more attention than they have received of late, not least because the intriguing questions they pose about the preservation of ancient landscapes were hinted at in passing in the 1960s and have recently re-surfaced. As we begin to ask again some of the grand questions that lay at the heart of geomorphology in its earliest days, large-scale geomorphology is on the threshold of another ,golden' era to match that of the first half of the 20th century, when cyclical approaches underpinned virtually all geomorphological work. Copyright © 2007 John Wiley & Sons, Ltd. [source] Experimental study of rill bank collapseEARTH SURFACE PROCESSES AND LANDFORMS, Issue 2 2007Jovan R. Stefanovic Abstract Rill bank collapse is an important component in the adjustment of channel morphology to changes in discharge and sediment flux. Sediment inputs from bank collapse cause abrupt changes in flow resistance, flow patterns and downstream sediment concentrations. Generally, bank retreat involves gradual lateral erosion, caused by flow shear stress, and sudden bank collapse, triggered by complex interactions between channel flow and bank and soil water conditions. Collapse occurs when bank height exceeds the critical height where gravitational forces overcome soil shear strength. An experimental study examined conditions for collapse in eroding rill channels. Experiments with and without a deep water table were carried out on a meandering rill channel in a loamy sand and sandy loam in a laboratory flume under simulated rainfall and controlled runon. Different discharges were used to initiate knickpoint and rill incision. Soil water dynamics were monitored using microstandpipes, tensiometers and time domain reflectometer probes (TDR probes). Bank collapse occurred with newly developed or rising pre-existing water tables near rill banks, associated with knickpoint migration. Knickpoint scour increased effective bank height, caused positive pore water pressure in the bank toe and reduced negative pore pressures in the unsaturated zone to near zero. Matric tension in unsaturated parts of the bank and a surface seal on the ,interrill' zone behind the bank enhanced stability, while increased effective bank height and positive pore water pressure at the bank toe caused instability. With soil water contents >35 per cent (sandy loam) and >23 per cent (loamy sand), critical bank heights were 0·11,0·12 m and 0·06,0·07 m, respectively. Bank toe undercutting at the outside of the rill bends also triggered instability. Bank displacement was quite different on the two soils. On the loamy sand, the failed block slid to the channel bed, revealing only the upper half of the failure plane, while on the sandy loam the failed block toppled forwards, exposing the failure plane for the complete bank height. This study has shown that it is possible to predict location, frequency and magnitude of the rill bank collapse, providing a basis for incorporation into predictive models for hillslope soil loss or rill network development. Copyright © 2006 John Wiley & Sons, Ltd. [source] Spatial and temporal variations in bank erosion on sand-bed streams in the seasonally wet tropics of northern AustraliaEARTH SURFACE PROCESSES AND LANDFORMS, Issue 9 2006M. J. Saynor Abstract Bank erosion rates and processes across a range of spatial scales are poorly understood in most environments, especially in the seasonally wet tropics of northern Australia where sediment yields are among global minima. A total of 177 erosion pins was installed at 45 sites on four sand-bed streams (Tributaries North and Central, East Tributary and Ngarradj) in the Ngarradj catchment in the Alligator Rivers Region. Bank erosion was measured for up to 3·5 years (start of 1998/99 wet season to end of 2001/02 wet season) at three spatial scales, namely a discontinuous gully (0·6 km2) that was initiated by erosion of a grass swale between 1975 and 1981, a small continuous channel (2·5 km2) on an alluvial fan that was formed by incision of a formerly discontinuous channel between 1964 and 1978, and three medium-sized, continuous channels (8·5,43·6 km2) with riparian vegetation. The bank erosion measurements during a period of average to above-average rainfall established that substantial bank erosion occurred during the wet season on the two smaller channels by rapid lateral migration (Tributary Central) and by erosion of gully sidewalls due to a combination of within-gully flows and overland flow plunging over the sidewalls (Tributary North). Minor bank erosion also occurred during the dry season by faunal activity, by desiccation and loss of cohesion of the sandy bank sediments and by dry flow processes. The larger channels with riparian vegetation (East Tributary and Ngarradj) did not generate significant amounts of sediment by bank erosion. Deposition (i.e. negative pin values) was locally significant at all scales. Bank profile form and channel planform exert a strong control on erosion rates during the wet season but not during the dry season. Copyright © 2006 Commonwealth Government of Australia. [source] | ||||||||||||||||||||||||||||||||||||||||||||||