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Surgical Alternative (surgical + alternative)
Selected AbstractsSurgical alternatives for treating Peyronie's diseaseBJU INTERNATIONAL, Issue 6 2004Chris K. Tornehl First page of article [source] Rosacea and its management: an overviewJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 3 2005AK Gupta ABSTRACT Background, Rosacea is a chronic inflammatory disorder that affects 10% of the population. The prevalence of rosacea is highest among fair-skinned individuals, particularly those of Celtic and northern European descent. Since a cure for rosacea does not yet exist, management and treatment regimens are designed to suppress the inflammatory lesions, erythema, and to a lesser extent, the telangiectasia involved with rosacea. Objectives, This review outlines the treatment options that are available to patients with rosacea. Methods, Published literature involving the treatment or management of rosacea was examined and summarized. Results, Patients who find that they blush and flush frequently, or have a family history of rosacea are advised to avoid the physiological and environmental stimuli that can cause increased facial redness. Topical agents such as metronidazole, azelaic acid cream or sulfur preparations are effective in managing rosacea. Patients who have progressed to erythematotelangiectatic and papulopustular rosacea may benefit from the use of an oral antibiotic, such as tetracycline, and in severe or recalcitrant cases, isotretinoin to bring the rosacea flare-up under control. Treatment with a topical agent, such as metronidazole, may help maintain remission. Patients with ocular involvement may benefit from a long-term course of an antibiotic and the use of metronidazole gel. A surgical alternative, laser therapy, is recommended for the treatment of telangiectasias and rhinophyma. Patients with distraught feelings due to their rosacea may consider cosmetic camouflage to cover the signs of rosacea. Conclusions, With the wide variety of oral and topical agents available for the effective management of rosacea, patients no longer need to feel self-conscious because of their disorder. [source] Psoriatic arthritis of the temporomandibular joint , a surgical alternative to treating a medical problemORAL SURGERY, Issue 1-2 2010R. Popat Abstract We describe the case of a 43-year-old female who suffered pain and profound functional impairment in both tempormandibular joints (TMJ), secondary to psoriatic arthritis. The inability to eat and talk without severe pain had rendered the patient unable to seek employment and with a poor quality of life. Her symptoms had proved refractory to anti-TNF medication (Etanercept) and other treatments such as hydrocortisone injections and bilateral TMJ condylar shaves. The patient underwent bilateral total temporomandibular joint (TMJ) replacements in May 2008. Her recovery was uneventful and she is now pain-free and has a vastly improved quality of life. This case gives an overview of psoriatic arthritis, especially as it affects the TMJ and highlights the benefits of total TMJ replacement. We recommend that consideration should be given to its use as a surgical alternative in cases which prove refractory to medical management. [source] Vascularized Cadaveric Fibula Flap for Treatment of Erectile Dysfunction Following Failure of Penile ImplantsTHE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010Christopher J. Salgado MD ABSTRACT Introduction., Postpriapism erectile dysfunction in patients with sickle cell disease is a particularly devastating condition. Where penile implants have failed, there is no good surgical alternative at present. Free tissue transfer is fraught with risks in patients with sickle cell disease and are not the best option for treatment. Aim., To describe a new surgical technique involving prefabrication of a bone flap for treatment of erectile dysfunction in a patient with sickle cell disease. Methods., The descending branch of the lateral circumflex femoral artery was isolated and implanted within a cadaveric bone segment. The prefabricated flap was then transferred 2 months later as a neophallus for penile autoaugmentation. Results., Bone scan showed viability of the bone flap after transfer. The patient was able to have vaginal intercourse and successfully achieve orgasm 2 months after the second stage surgery. Conclusions., Prefabrication of a cadaveric bone flap and subsequent transfer is a novel and effective technique for treatment of erectile dysfunction refractory to medical management. This technique may be particularly useful for "implant cripples," who have no other surgical option. Salgado CJ, Chim H, Rowe D, and Bodner DR. Vascularized cadaveric fibula flap for treatment of erectile dysfunction following failure of penile implants. J Sex Med 2010;7:3504,3509. [source] Surgical Outcomes Following the Endoscopic Modified Lothrop Procedure,THE LARYNGOSCOPE, Issue 5 2007Mobeen A. Shirazi MD Abstract Objective: We performed a systematic review of 97 patients in whom an entirely endoscopic modified Lothrop procedure (EMLP) was performed. We studied the safety, efficacy, need for revision surgery, and rate of complication following an EMLP. Study Design: The study design was a retrospective chart analysis. Methods: We performed a retrospective chart review and patient survey of 97 patients who underwent an EMLP at our institution from January 1999 to March 2006. Main outcomes measured were the need for revision surgery including an osteoplastic flap (OPF), improvement in patients' symptoms, and rate of cerebrospinal fluid (CSF) leak. Results: The most common indication for the procedure was chronic frontal sinusitis and/or formation of mucocele. The frontal recess and floor of the frontal sinus were the most common areas of persistent disease. CSF leak rate was 1% (1/97) and was managed successfully at the time of surgery without any long-term sequelae. Twenty-two (23%) patients required revision surgery. Three (3%) patients required revision with an OPF. Some degree of symptomatic clinical improvement was reported by 98% (95/97) of patients. Conclusion: EMLP is a safe and effective surgical alternative to OPF for patients with recalcitrant frontal sinus disease. Major complications are rare. A large percentage of patients may require revision surgery. [source] Osteoradionecrosis with Combined Mandibulotomy and Marginal MandibulectomyTHE LARYNGOSCOPE, Issue 11 2005Chih-Chun Wang MD Abstract Introduction: To evaluate the outcome of simultaneous anterior mandibulotomy and marginal mandibulectomy for patients with oral cavity cancer. Material and Methods: The medical charts of seven patients who underwent simultaneous anterior mandibulotomy and marginal mandibulectomy for oral cavity cancer between July 1994 and June 2004 in Chang Gung Memorial Hospital, Taiwan were retrospectively reviewed. These seven patients had no prior radiation therapy nor clinical or radiographic evidence of mandible bone invasion. Results: Seven patients, between 34 to 62 years of age, were followed up in the clinics from 4.5 to 39 months with an average of 19.4 months. Five (71%) patients developed mandible osteoradionecrosis. Among them, two patients underwent radical sequestrectomy followed by reconstruction with a free fibular osteoseptocutaneous flap or soft tissue flap, and the other three patients either received removal of the mandible fixation miniplate, limited sequestrectomy of the mandible, or conservative antibiotic treatment individually. Conclusions: Simultaneous anterior mandibulotomy and marginal mandibulectomy results in a high morbidity rate of avascular necrosis of the mandible and therefore should be avoided. To avoid a disastrous complication, segmental mandibulectomy and a composite free fibular osteoseptocutaneous flap reconstruction would be a preferred surgical alternative. [source] Modified De Vita pinning technique for the management of canine hip luxation: preliminary findingsAUSTRALIAN VETERINARY JOURNAL, Issue 8 2000IH DOUGLAS Objective To describe for the first time a modification of the De Vita pinning technique to manage hip luxation in the dog and to assess its use in a preliminary study. Design A prospective, clinical study using five client-owned dogs with naturally occurring injuries. Procedure A modified De Vita pinning technique was employed, using a nonthreaded Steinmann pin to reduce the risk of trauma to the sciatic nerve during pin insertion. The pin was anchored by implanted Kirschner-Ehmer clamps in an attempt to lower the risk of postoperative pin migration. Results Surgical outcome was very favourable with respect to pain on manipulation, restriction of range of movement and lameness in all dogs as assessed by veterinary examination. In four of five dogs, owners also reported normal movement at rest, walk and trot. The fifth dog was lost to follow-up. Conclusion This preliminary study found that a modified De Vita pinning technique was useful in dogs with uni and bilateral hip luxation and hip luxation in the presence of other limb injuries. The modified technique may provide a sound surgical alternative to existing procedures. The described modification allows the use of a nonthreaded pin and also substantially reduces the risk of postoperative pin migration. [source] Efficacy of combined cyclosporine A and ketoconazole treatment of anal furunculosisJOURNAL OF SMALL ANIMAL PRACTICE, Issue 5 2004T. O'Neill Cyclosporine A and ketoconazole were used as a combined therapy to treat 19 dogs with anal furunculosis. Complete resolution of all lesions was achieved in three to 10 weeks, but recurrences occurred in seven of the 19 dogs (36.8 per cent), with remission periods extending from one to six months for these dogs. Adverse effects of treatment included excessive hair loss, intermittent lethargy, vomiting and decreased appetite in some dogs, but none of the signs were considered serious. The results of treatment are comparable with, if not better than, the surgical alternatives. There is an approximate 70 per cent cost saving over the use of cyclosporine alone. [source] Surgical complications and medium-term outcome results of tension-free vaginal tape: A prospective study of 313 consecutive patientsNEUROUROLOGY AND URODYNAMICS, Issue 1 2004Ishai Levin Abstract Objective A prospective study was undertaken to examine the incidence of surgical complications and medium-term outcomes of tension-free vaginal tape (TVT) surgery in a large, heterogeneous group of stress-incontinent women. Methods Surgery was tailored according to preoperative clinical and urodynamic findings: stress-incontinent women underwent TVT surgery, whereas those with concomitant urogenital prolapse underwent combined TVT and prolapse repair. Post-operatively the patients were scheduled for evaluation at 1, 3, 6, and 12 months, and annually thereafter. All underwent urodynamics at 3 months post-operatively. Results Three hundred and thirteen consecutive patients were prospectively studied. The mean follow-up period was 21.4,±,13.5 months. Sixteen (5.1%) cases of intravesical passage of the prolene tape occurred in our series, two of which were diagnosed at 3 and 15 months post-operatively. Eight (2.5%) patients had post-operative voiding difficulties, necessitating catheterization for more than 7 days. However, transvaginal excision of the tape was required in one case only. Vaginal erosion of the tape was diagnosed in four (1.3%) patients, all of whom were successfully treated by local excision of the eroded tape. Outcome analysis was restricted to 241 consecutive patients with at least 12 months of follow-up. Subjectively, 16 (6.6%) patients had persistent mild stress urinary incontinence, although urodynamics revealed asymptomatic sphincteric incontinence in 17 (7%) other patients. De-novo urge incontinence developed post-operatively in 20 (8.3%) patients. Conclusions The TVT procedure is associated with good medium-term cure rates, however, it is not free of troublesome complications and the patients should be informed accordingly. Only well-trained surgeons, familiar with pelvic anatomy, surgical alternatives, and endoscopic techniques should perform the operation. Neurourol. Urodynam. 23:7,9, 2004. © 2003 Wiley-Liss, Inc. [source] | ||||||||||