Simple choristoma of the anterior segment containing brain tissue

We report an unusual case of a simple choristoma of the anterior segment that contained only brain tissue. The clinical characteristics and findings of pathological examination of this unusual ocular malformation were reviewed. A newborn girl was seen with a fleshy, highly vascular cystic mass arising from the inferior limbus and extending across the cornea. On a computed tomographic scan, gross disruption of the anterior segment was present, with subluxation of the lens into the cyst. Excision of the abnormal tissue was followed by evisceration; polyglactin (Vicryl) ball implantation; patch graft of the globe; and, later, prosthetic fitting. Pathologic findings showed a choristomatous malformation, containing only mature brain tissue. To our knowledge, a choristoma in which the sole constituent is brain tissue has not previously been reported.     

Neonatal hyperinsulinism--surgical and pathologic considerations

Hyperinsulinism in infancy is most often associated with a diffuse pancreatic lesion designated islet-cell dysmaturation syndrome. This disease is commonly associated with persistent hypoglycemia which usually results from inappropriate secretion of insulin. Urgent medical therapy consisting of hypertonic glucose infusion, frequent feeding, and diazoxide is mandatory in order to prevent central nervous system damage. Where medical means of therapy are not effective, an early 85% subtotal pancreatectomy with preservation of the spleen, is indicated. Nine infants who suffered from hyperinsulinism are reported. In two, medical measures were sufficient to control the disease. One of these patients in whom treatment was started late, remained slightly mentally retarded. Seven patients underwent 85% pancreatectomy. In one of these, an additional 7.5% of the pancreas had to be removed and in a second patient total pancreatectomy was performed in order to control the disease. One patient died on the eighth postoperative day after acute gastric perforation. There was no evidence of residual brain damage in the patients who underwent subtotal pancreatectomy.     

Anthropometry of the scapula: clinical and surgical considerations

Hospital discharge on the day after an uncomplicated vaginal delivery may be appropriate if clinical criteria are used for the selection of patients and post-discharge follow-up plans are in place. To ensure safety for these patients, Advocate Health Care developed a mother/baby philosophy statement, guidelines for maternal and infant discharge in less than 48 hours, and an algorithm to assure that appropriate follow-up care takes place after discharge. To evaluate the Mother/Baby Home Transition Program, home health follow up, readmission rates, and sentinel events were tracked. Most home health visits occurred within 48 hours. Infant readmission rates ranged from 1.1-2.6%, whereas maternal readmission rates ranged from 0-0.52%. Three sentinel events in 1996 and three in 1997 required readmissions to an ICU. Data continue to be monitored and shared monthly with clinical leaders.     

Implant placement: surgical techniques and considerations

Successful implant surgery largely depends on good planning and meticulous technique. The former requires an appreciation of the restorative requirements and visualization of the desired end result. This may be easier for the clinician who is delivering both aspects of treatment, but in other circumstances requires close collaboration between prosthodontist and surgeon. This paper focuses on the surgical techniques involved in implant surgery, because successful osseointegration is achievable only with careful surgical preparation.     

Brain heterotopia: choristoma of the back

Heterotopic brain tissue, except in the head and neck region, is exceedingly rare. Mature neural tissue unexpectedly found in the subcutaneous tissues of the back of a toddler lacked an attachment to the central nervous system (CNS), and appeared to be unorganized glial tissue on pathologic evaluation. Appropriate clinical management of such lesions includes a suspicion of subcutaneous lesions near the CNS and evaluation to eliminate the presence of communication with the CNS, followed by surgical excision.     

Anterior approaches to the spinal column: considerations of the surgical technic

The anterior approach to the vertebral column is indicated in the tumors or traumas of the vertebral body with prevalent anterior expression. This method allows to control easily all the structures in front of the rachis. Furthermore, the current reconstructive techniques require the exposure of a long tract of the vertebral column. The Authors report their experience with the anterior approach in 22 patients (9 males, 13 females) affected by different pathologies: 10 primary tumors divided as follows: 4 sacral chordomas, 1 L1 chordoma, 2 sacral neurinomas, 1 L5 malignant melanotic schwannoma, 1 D9 osteoblastoma, 1 D6 intraspinal cavernoma, and 1 D3 myeloma; 4 metastatic tumors (2 D10, 1 L4 and 1 L5); 5 fractures of the vertebral body (1 L1, 1 L1-L2, 2 L4 and 1 L5); 2 echinococcal cysts respectively arising from the D11 body, the sacrum and ilium. The Authors overall performed 8 thoracotomies, 6 for dorsal location; in 1 case of L1-L2 fracture a thoracophrenolaparotomy was performed; in 7 cases involving the L3-L5 segment an abdominal anterolateral extraperitoneal approach was followed; finally in 6 cases a transperitoneal laparotomy to approach the sacrum and ilium was performed.     

Anesthetic considerations for the pediatric plastic surgical patient

An understanding of the anesthesiologist's concerns during pediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Prior to surgery, the child's history is obtained and physical examination is performed. The condition of the airway is the primary concern. Preoperative medication is usually given by oral routes to avoid injections. Induction intubation, maintenance, and emergence are discussed. Specific postanesthesia care is described. Special precautions are given for children having surgical repair of craniofacial anomalies. Cleft lip and palate and mandibular advancement are described.     

Mediastinal cyst involving the oesophagus: diagnosis and results of surgical treatment

OBJECTIVE: To describe our experience with mediastinal cysts involving the oesophagus. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: 11 patients who presented to our department with a mediastinal cyst from 1976-1994. INTERVENTIONS: Excision of the mass through a posterolateral thoracotomy (n = 10) or by video-assisted thoracoscopy. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: 8 patients presented with retrosternal or epigastric pain, three of whom had mild dysphagia. In the remaining 3 the tumour was asymptomatic and an incidental finding on a chest radiograph. Endoscopic ultrasonography and computed tomography (CT) allowed preoperative diagnosis of an extramucosal cyst in 5 of the 7 patients investigated by both tests. Masses were excised through a formal thoracotomy (n = 10) or by video-assisted thoracoscopy. Histological examination confirmed a benign cyst in all cases. There was no operative morbidity and nine patients are free of symptoms after a median follow-up of 2.3 years. CONCLUSION: Excision, preferably by thoracoscopy, is the treatment of choice for mediastinal cysts that involve the oesophagus. Special attention should be paid to the vagal nerves, and as many as possible of the muscular layers of the oesophagus should be preserved.     

Treatment planning and surgical considerations for placement of wide-body implants

Partially edentulous implant treatment has evolved from using a standard diameter fixture for every tooth site to selection of the implant diameter according to the surgical demands, space available, and the dimension of the final prosthetic tooth. The advantages are functional, improved emergence profiles for esthetics, and optimal contours for oral hygiene maintenance. This article reviews presurgical treatment planning for wide-diameter implants.     

Lingual osseous choristoma: a study of eight cases and review of the literature

A choristoma is a tumor-like mass of normal tissue in an "abnormal" location. Lingual osseous choristoma, previously known as osteoma of the tongue, is a rare entity: we found documentation of eight cases at our center during the 10-year period between 1987 and 1996. These cases were analyzed along with 50 others reported in the English language literature between 1913 and 1996. Lingual osseous choristoma frequently occurs during the third and fourth decades of life, and predominantly affects women (81%). Most of the osseous choristomas in our review were located in the posterior third of the tongue, primarily at or close to the foramen cecum or circumvallate papillae (87.9%). While 39.7% of the patients were asymptomatic, the remaining patients complained of symptoms including a lump in the throat (25.8%), dysphagia (6.9%), gagging (5.1%), nausea (3.4%) and irritation (3.4%). Treatment of lingual osseous choristoma consists of simple excision. The tumor's origin has been discussed elsewhere.     

A new method for the surgical treatment of patients with paralysis of the tongue

Skeletal muscle biopsies from 18 children and 8 from their mothers were studied in mitochondrial myopathies. It is shown that by means of electron microscopy, histochemistry, and morphometry the correct diagnosis of mitochondrial insufficiency is quite possible.     

Prosthetic considerations in the fabrication of surgical stents for implant placement

The utilization of surgical stents/templates for implant placement is of significant importance to the success of the definitive prosthesis. However, major conceptual differences exist between surgical stents designed for implant-supported crowns and bridges and those designed for implant overdentures. In addition, various types of surgical stents exist within each group. In either case, optimizing the prosthetic result by customization of the stent should be a major consideration in the fabrication process. The design of the stent must account for several treatment conditions, including position of the implant, the tissue present, and the anticipated prosthesis. The teaching objective of this article is to present the prosthetic considerations in the fabrication and customization of surgical stents. The article compares the two groups and offers specific guidelines for the fabrication of surgical stents for the various types of restorations within each group.     

Indications for reduction of tongue in surgical treatment of mandibular prognathism

It is suggested that there should be available post-graduate training schemes for members of the profession who ultimately wish to work on an Intensive Therapy Unit at Consultant level. The duties of the Medical Unit administrator are described and schemes are suggested for further training of an anaesthetist or physician particularly interested in critical patient care.     

The rotator cuff-deficient arthritic shoulder: diagnosis and surgical management

The symptomatic rotator cuff-deficient, arthritic glenohumeral joint poses a complex problem for the orthopaedic surgeon. Surgical management can be facilitated by classifying the disorder in one of three diagnostic categories: (1) rotator cuff-tear arthropathy, (2) rheumatoid arthritic shoulder with cuff deficiency, or (3) degenerative arthritic (osteoarthritic) shoulder with cuff deficiency. If it is not possible to repair the cuff defect, surgical management may include prosthetic arthroplasty, with the recognition that only limited goals are attainable, particularly with respect to strength and active motion. Glenohumeral arthrodesis is a salvage procedure when other surgical measures have failed. Arthrodesis is also indicated in patients with deltoid muscle deficiency. Humeral hemiarthroplasty avoids the complications of glenoid loosening and is an attractive alternative to arthrodesis, resection arthroplasty, and total shoulder arthroplasty. The functionally intact coracoacromial arch should be preserved to reduce the risk of anterosuperior subluxation. Care should be taken not to "overstuff" the gleno-humeral joint with a prosthetic component. In cases of significant internal rotation contracture, subscapularis lengthening is necessary to restore anterior and posterior rotator cuff balance. If the less stringent criteria of Neer's "limited goals" rehabilitation are followed, approximately 80% to 90% of patients treated with humeral hemiarthroplasty can have satisfactory results.