A new technique for nasal tip cartilage graft in primary rhinoplasty

Inadequate tip projection in traditional rhinoplasty led to postrhinoplasty deformity, which with time got worse. Sheen's vertical shield and Peck's horizontal multiple rectangular stacked cartilage graft have been used to reduce postrhinoplasty tip projection loss. The new two fixed column disk cartilage graft technique at the tip-defining points is designed to combine the advantages of both techniques. This technique can be used in both open and closed rhinoplasty, and the amount of projection can be adjusted to fit the dorsum with relative ease. This technique has been used in 38 primary rhinoplasties with satisfactory results.     

A new nitrogen alloying technique - a way to distinctly improve the properties of austenitic steel

The paper presents a new process for nitrogen alloying austenitic steels beyond solubility limit in a pressurized electroslag remelting furnace using Si₃N₄ as nitrogen source. With the aid of this process it is possible to attain nitrogen percentages far beyond the solubility limit at atmospheric pressure. These high nitrogen contents impart a distinct improvement to the properties of the material. Yield strengths R_p0.2>600 N/mm² at ambient temperature are achieved. The high tensile values are attributable to the lattice expanding effect of force-dissolved nitrogen. A reduction in forming characteristics A₅ and Z normally associated with a distinct increase in tensile strength is not noticeable. The tests at ambient temperature have further shown that nitrogen alloyed steels display high fatigue strength values. If results of the fatigue tests are evaluated on the basis of the empirical relation 0.30 < σ_zdw/R_m<0.45 it is found that the values of the steels tested are generally at the upper limit of this value or even above it. The very good creep test results of nitrogen alloyed steels deserve emphasis. Up to 800°C they are comparable to the creep values of high temperature alloys. This is attributable to the precipitation behaviour of the steels caused by the presence of nitrogen. Embrittlement occurs only to a very small extent and precipitates, in particular Cr₂N, enhance creep resistance owing to their favourable arrangement. The new technique of nitrogen alloying beyond the solubility limit opens up favourable opportunities for nitrogen alloyed austenitic steels in new applications. This development offers further advantages in that considerable savings in nickel as an alloying element can be made and that material can be much better utilized in the design of components.     

The sinus lift graft: basic technique and variations

Following an early controversy concerning its efficacy, the sinus lift and graft technique is now considered to be a state-of-the-art surgery. In 1975, Tatum introduced the technique that increased maxillary bone height by placing graft material under the maxillary sinus and Schneiderian membrane; by the early 1990s, a modification of Tatum's original technique had become a standard procedure. This article describes and illustrates three variations of the basic sinus lift surgery and graft operation--the hinge osteotomy, the elevated osteotomy, and the complete osteotomy. Additional considerations affecting the surgical outcome are also discussed as is the management of possible complications. The learning objective of this article is to obtain up-to-date information regarding the basic technique and variations of the sinus lift procedure to the general practitioner as well as the specialist.     

提高煤矿瓦斯抽放效果的控制爆破技术

瓦斯抽放是我国治理瓦斯灾害的主要措施,目前抽放率较低．采用控制爆破技术进行提高瓦斯抽放效果的研究,解决了在高瓦斯煤层爆破的安全起爆、长水平炮孔中的装药技术和炸药品种的选择等问题．爆破后瓦斯自排量较非爆区提高5倍以上,抽放率提高明显,抽放时间缩短1/3以上．     

Iliotibial band for anterior cruciate ligament reconstruction: a new technique for graft augmentation, placement and fixation

A simple surgical technique to reconstruct the ACL deficient knee was described. A strip of ITB and fascia lata augmented by degradable suture materials was used as the substitute. The strip was introduced into the isometric area of the original ACL attachment through a drill hole made in the lateral femoral condyle. Drilling was guided by the anatomical landmarks without using special device. The graft was then rigidly fixed to the tibia by intraosseous compression, the method previously described by the author. Clinical results were assessed by both subjective symptoms and physical examinations. In 33 patients followed-up for an average of 34.1 months, thirty of them who were chronic cases had few or no symptoms concerning pain, swelling, laxity and stiffness at the last visit. Lachman test, anterior drawer and Slocum test were negative in 87.92, 81.87 and 100 per cent respectively. This technique requires only basic instruments and skill, and is thus generalizable to institutions having limited surgical facilities.     

Techniques to improve physicians' use of diagnostic tests: a new conceptual framework

OBJECTIVES: To review the published literature on interventions aimed at improving physicians' testing practices and propose methodologic standards for these studies and to review selected studies using the PRECEDE framework, a behavioral model that helps categorize interventions based on which behavioral factors are being affected. DATA SOURCES: MEDLINE, EMBASE, and HEALTHStar databases were searched for the years 1966 to January 1, 1998, for English-language articles pertaining to diagnostic testing behavior; bibliographies were scanned to identify articles of potential interest; and researchers in health services, health behavior, and behavior modification were contacted for proprietary and other unpublished articles. STUDY SELECTION: A total of 102 articles were identified that described the results of interventions aimed at changing physicians' testing practices. We included the 49 studies that compared diagnostic testing practices in intervention and control groups. DATA EXTRACTION: Two investigators independently reviewed each article in a blinded fashion using a standard data collection form to obtain a methodologic score and to abstract the key elements of each intervention. DATA SYNTHESIS: On a 38-point methodologic criteria scale, the mean +/- SD score was 13+/-4.4. The desired behavior change was reported in the intervention group in 37 (76%) of 49 studies. Twenty-four (86%) of 28 interventions targeted at many behavioral factors were successful, while 13 (62%) of 21 studies aimed at a single behavioral factor were successful (P=.12). CONCLUSIONS: A majority of interventions to improve physicians' testing practices reported in the literature claimed success, with interventions based on multiple behavioral factors trending toward being more successful. While methodologic flaws hamper drawing strong conclusions from this literature, application of a behavioral framework appears to be useful in explaining interventions that are successful and can facilitate interpretation of intervention results.     

External cantilever sling in septorhinoplasty: a new technique

Development of mucoperichondrial and mucoperiosteal flaps bilaterally, total removal of the deviated septum, straightening it outside, followed by replacement as a free graft constitute an option in treatment of the severely deviated nose. Positioning and stabilization of the septum in this technique may prove insufficient in the majority of septorhinoplasty patients in whom both nasal bones are also immobilized. Positioning and stabilization can be achieved adequately by the use of the presented technique that involves passing a 3-0 nylon suture to suspend the cartilage replant to a plastic splint applied to the dorsum of the nose, one-third of which is taped over the realigned nasal bones. In the past 5 years, 45 patients have undergone septorhinoplasty using this technique. The minimum follow-up period was 6 months. No patient developed any major complications. Secondary correction was necessary to improve the aesthetic result in only one patient. The results in patients who underwent this surgical procedure suggest that the presented technique provides excellent results in severely deviated noses associated with major deviations of the septum but must be limited only to those whose deformity is so severe that other techniques will be insufficient to obtain the desired result.     

Starplasty: a new technique of pediatric tracheotomy

OBJECTIVE: To report a new technique of pediatric tracheotomy that reduces the problems of pneumothorax and recannulation after accidental decannulation in a recently performed tracheotomy. DESIGN: Retrospective chart review for 1990-1997. PATIENTS: Sixty-eight children aged between 2 days and 14 years. METHOD: The starplasty procedure is based on the geometry of a 3-dimensional Z-plasty. The technique of the procedure is described and illustrated in detail. RESULTS: There were 27 short-term complications, including 4 accidental decannulations. There were no instances of pneumothorax or tracheotomy-related deaths. There were 25 long-term minor complications. There were no instances of tracheotomy-related death, suprastomal collapse, or tracheal stenosis. Thirty-eight children remain tracheotomy tube dependent, 17 underwent decannulation, 7 died of primary disease, and 6 were lost to follow-up. All 17 children who underwent decannulation have a persistent tracheocutaneous fistula. CONCLUSIONS: I conclude that starplasty reduces the incidence of major complications and death. Its only drawback seems to be persistent tracheocutaneous fistula.     

Lumbar epidural perineural injection: a new technique

Molecular variants of individual components of the renin-angiotensin system (RAS) are reported to constitute the inherited predisposition to some cardiovascular diseases in man, e.g. essential hypertension or myocardial infarction. The frequency of these variants depends highly on the race and population. Therefore, we examined the M235T molecular variant of the angiotensinogen gene and the I/D polymorphism of the ACE gene in Slovak healthy population, in patients with diagnosed essential hypertension and in patients who had undergone myocardial infarction. DNA from 241 subjects was tested for the presence of M235T and I/D molecular variants. The frequency of both these polymorphisms in the Slovak population is similar to other Caucasian populations. In the group of hypertensive patients, the frequency of the M235T molecular variant was increased compared to controls, predominantly in males (0.45 vs. 0.28), while in the I/D polymorphism the incidence of the D allele was the same for both controls and hypertensives (0.49 vs. 0.50). A significant increase in the D allele frequency compared to the controls occurred in the group of infarcted patients (0.63). The increased frequency of the M235T allele in hypertensive patients compared to the healthy population confirms that the M235T variants associated with increased blood pressure in the Slovak population. In the Slovak population, I/D polymorphism of the ACE gene is associated with myocardial infarction rather than with hypertension.     

A new microporous polyurethane vascular graft prepared by an excimer laser ablation technique

Three types of polyurethane (PU) based tubes (internal diameter, 2 mm; wall thickness, 100 microns) with micropores of well controlled size and arrangement were fabricated using an excimer laser (KrF) ablation technique. The pore size (100 microns) and the longitudinal pore-to-pore distance (200 microns) were constant, and the circumferential pore-to-pore intervals were 60 degrees (type 1), 30 degrees (type 2), and 15 degrees (type 3). The surface of the fabricated tube was photochemically modified with photoreactive gelatin. Scanning electron microscopy showed that pore size and arrangement were precisely controlled as designed, and that a gelatinous layer thoroughly covered the luminal surface. The stiffness parameter (beta), inversely related to compliance, was determined from the change in external diameter against intraluminal pressure. An increase in the number of pores around the circumference decreased the beta value. The type 1 tubes implanted preliminarily in rats for 4 weeks showed good patency (80%). The combination of excimer laser-directed microporing and photochemical surface processing techniques enabled the development of a novel compliant small caliber vascular graft, which is expected to show enhanced transmural tissue ingrowth in vivo.     

Evaluation of the susceptibility of dermatophytes to antifungal drugs: a new technique

The evaluation of the minimal inhibitory concentration (MIC) for pathogenic fungi is still a technically difficult assay. Insufficient standardization of the technique is often the basis of problems which appear. Culture characteristic of dermatophytes do not favour techniques usually used in bacteriology (Steers agar dilution method). A study was undertaken to compare the Steers agar dilution method and a new culture method to evaluate the minimal inhibitory concentration of antifungal compounds on several species of dermatophytes. The new method involves dilution of the antifungal drug in solid medium in a Petri dish. Standardized agar cylinders are cut from the plates and filled with inocula of the same size cut from plates of dermatophyte cultures. Such inocula facilitate analysis of the fungus in its natural growth conditions in vitro without being submitted to a disruptive preparative technique. The MIC values were similar for the two methods of evaluation in spite of important differences between the inocula. The new technique is reliable, quick, and highly reproducible. It is more efficient than the Steers agar dilution method because it enables assays to be run on several strains simultaneously and avoids labour-intensive procedures for the preparation of the inocula.     

Laparoscopic cholangiography: a new technique for difficult cannulation

PURPOSE: To test the hypothesis that rejection could affect the contractility and contractile reserve of left ventricle after heart transplantation. METHODS: Echocardiographic parameters and noninvasive blood pressure end-systolic pressure (ESP), heart rate (HR), end diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (EF), end-systolic stress (ESS) and the end-systolic relation (ESS/ESV) were recorded in 68 studies in 11 patients, seven days-12 months after heart transplantation. Accordingly with the endomyocardial biopsies results were divided into two groups: group A-with no rejection (53 studies), and group B-with rejection (15 studies). RESULTS: The nitroprusside infusion changed significantly and in the same way, all the parameters except the ESS/ESV ratio (A = 5.5 +/- 1.7 x B = 4.8 +/- 1.5 g/cm2/mL, p = NS); there was a decrease in ESP (A = 107 +/- 15 and B = 109 +/- 12 mmHg, p = NS), EDV (A = 68 +/- 19 and B = 81 +/- 12 mL, p = NS), ESV (A = 12 +/- 5 and B = 18 +/- 12 mL, p = NS) and ESS (A = 59 +/- 13 and B = 82 +/- 20g/cm2, p = NS); there was an increase in HR (A = 94 +/- 9 and B = 93 +/- 16bpm, p = NS) and EF (A = 83 +/- 5 and B = 79 +/- 8%, p = NS). In the dobutamine study it was observed differences for both groups, except for ESP (A = 156 +/- 26 and B = 149 +/- 26mmHg, p = NS). The increase in HR, EF and ESS/ESV ratio was greater in group A (HR-A = 117 +/- 19 and B = 102 +/- 25bpm, p < 0.05; EF-A = 91 +/- 4 and B = 78 +/- 11%, p < 0.05; ESS/ESV-A = 13.1 +/- 6 and B = 6.1 +/- 3.1 g/cm2/mL, p < 0.05). For group A it was smaller the EDV (57 +/- 18 x 94 +/- 35 mL, p < 0.05), ESV (5 +/- 3 x 24 +/- 20 mL, p < 0.05) and ESS (57 +/- 21 x 102 +/- 40 g/cm2, p < 0.05). CONCLUSION: Rejection may not induce changes in resting left ventricular contractility, however, the contractile reserve is depressed during an episode of moderate to severe rejection.     

Chairside-fabricated indirect resin restorations: a new articulated technique

A case report of a chairside-fabricated indirect resin composite restoration is used to introduce a modification to a newly released one-appointment resin inlay-onlay technique. Fast-setting poly(vinyl siloxane) die material accommodates an articulated working cast within 10 minutes. The technique allows the economical construction of large, occlusal, load-bearing, extracoronal resin composite restorations. The guarded prognosis associated with extensive posterior resin composite restorations is acknowledged; nevertheless this technique remains a realistic option for those financially compromised patients who request tooth-colored restorations.     

采用TPG冶炼技术提高冶炼回收率的生产实践

针对黑龙江省老柞山金矿中频炉炼金工艺中存在的问题。国家黄金管理局下达科研任务，解决原中频炉炼金所存在的问题。经现场考查，选择冶炼溶剂为碳酸钠，硼砂，石英砂，同时增加烟气收尘，过滤工序，完善了工艺流程。生产实践表明一次冶炼炉渣含金品位代于３０ｇ／ｔ，冶炼直收主达９。８２％，提高老柞山金矿冶炼回收率１６个厚分点，企业年增加经济效益２００万元。     

Partial replacement of an infected arterial graft by a new prosthetic polytetrafluoroethylene segment: a new therapeutic option

PURPOSE: As the title suggests, this is an account of treating infected arterial grafts other than by the accepted methods of complete graft removal and revascularization with autogenous material or extraanatomic bypass. METHODS: Since 1973, 42 patients with infected arterial grafts (n = 35) or autogenous reconstructions (n = 7) were seen with false aneurysm, hemorrhage, or perigraft or perianastomotic pus and were treated by removal of the infected graft and immediate adjacent or in situ revascularization by polytetrafluoroethylene (PTFE) in 39 cases and Dacron in three cases. Management plan included (1) removal of only the obviously infected part of the original graft, (2) obliteration of the infected anastomotic site, and (3) placement of the new PTFE graft in an adjacent clean or debrided route. So treated were 15 aortic Dacron grafts, 20 PTFE grafts (2 iliofemoral, 3 femorofemoral, and 15 femorodistal), and 7 autogenous reconstructions with bleeding. Partial graft salvage was attempted in 10 of 15 Dacron and 19 of 20 PTFE grafts. RESULTS: Four patients required further removal of the original infected graft (three Dacron, one PTFE), giving an ultimate success rate of 7 of 15 Dacron and 18 of 20 PTFE grafts; two patients required further obliteration of the original adjacent infected arterial segment because of rebleeding. An additional PTFE segment was joined successfully to incorporated PTFE in all six repeat operations. Initial failure did not prejudice the outcome; direct arterial flow to at least midthigh level was preserved in 37 of the 42 patients for a mean period of 40 months (range 9 to 130 months). Three of the new PTFE grafts occluded and became infected, which led to amputation and one death at a secondary operation. Visceral complications caused the only two other deaths in the aortic group. Five late amputations (four below the knee and one above the knee) were required because of femorodistal graft occlusion. CONCLUSIONS: Partial removal of infected grafts with adjacent or in situ replacement by PTFE is possible, simplifies management, and permits maintenance of distal circulation with low morbidity and mortality rates.     

External rhinoplasty: a useful approach for a young plastic surgeon

Among the frequently performed plastic surgery operations, rhinoplasty is the most difficult to obtain consistently good results. It is very challenging for young plastic surgeons to modify the external appearance of the nose and restore or maintain a good airway. The external approach has alleviated some of the problems due to understanding and learning of the rhinoplasty operation. Actually, open rhinoplasty allows better visualization of anatomical deformities and better manipulation of tissues allowing better integration of nasal anatomy and physiology. This paper reviews a personal series of 82 patients operated via an open approach between October 94 and October 97. During the same period, 24 patients were operated via an endonasal or percutaneous approach (osteotomies). Indications, advantages and disadvantages of the open approach are discussed. The various techniques used in this series are described and then critically analyzed. In open rhinoplasty, our present revision rate is 8.5%. In conclusion, the open approach seems to be useful for young rhinoplastic surgeons.     

The use of anti-D to improve post-transfusion platelet response: a randomized trial

Patients undergoing induction chemotherapy for acute leukaemia often become refractory to platelet transfusions. Increased clearance of transfused platelets due to alloimmune destruction has been identified as one of the primary mechanisms contributing to this refractory state. We performed a double-blind randomized trial to determine whether the administration of anti-D to Rh-positive individuals could prevent the refractory state and improve post-transfusion platelet response. Rh-positive patients with acute leukaemia undergoing induction chemotherapy and requiring platelet transfusions were allocated to weekly intravenous anti-D (20 micrograms/kg) or placebo. Platelets and red cell concentrates were administered according to standardized transfusion guidelines. Outcome measures included platelet transfusion utilization, red cell utilization, platelet recovery 18-24 h post-infusion, and the percentage of patients refractory to platelet transfusion. There were 43 patients studied: 21 received anti-D and 22 saline placebo. The mean number of platelet concentrates required per day of observation was 0.59 (SD 0.22) in the anti-D group and 0.61 (SD 0.22) in the placebo group, P = 0.86. No difference was detected between groups in terms of platelet recovery post-infusion, refractoriness to platelet transfusion or frequency of infection (P = 0.97). Red cell concentrate utilization was significantly increased in the anti-D group compared to the placebo group, 0.58 units per day versus 0.37 units per day respectively, P = 0.005. We conclude that the use of anti-D did not improve post-transfusion platelet response in Rh positive patients with acute leukaemia, but did result in an increased need for red cell transfusion.