Indications for and results of treatment of carotid artery stenosis

The authors discuss own experience with the treatment of carotid artery stenosis. Diagnostic principles and indications to surgical treatment, technique of block anesthesia, an operation and obtained results are also discussed. Internal carotid artery stenosis was treated surgically in 90 patients within 1985-1988. Block anesthesia enabling intraoperational control of patients' consciousness was used in 72 cases. Satisfactory early results were noted in 92.9% of patients. Two patients died after surgery whereas 5 patients suffered from neurological complications. Favourable late results (follow-up period ranged from 6 to 48 months) were noted in 64 out of 70 patients which reported to clinical examination (91.4%).     

Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers

Smoking results in impaired wound healing and poor surgical results. In this retrospective study, we compared outcomes in 155 smokers, 76 ex-smokers, and 517 nonsmokers who received postmastectomy breast reconstructions during a 10-year period. Ex-smokers were defined as those who had quit smoking at least 3 weeks before surgery. Transverse rectus abdominis musculocutaneous (TRAM) flap surgery was performed significantly less often in smokers (24.5 percent) than in ex-smokers (30.3 percent) or nonsmokers (39.1 percent) (p < 0.001). Tissue expansion followed by implant was performed in 112 smokers (72.3 percent), 50 (65.8 percent) ex-smokers, and 304 nonsmokers (58.8 percent) (p = 0.002). The overall complication rate in smokers was 39.4 percent, compared with 25 percent in ex-smokers and 25.9 percent in nonsmokers, which is statistically significant (p = 0.002). Mastectomy flap necrosis developed in 12 smokers (7.7 percent), 2 ex-smokers (2.6 percent), and 8 nonsmokers (1.5 percent) (p < 0.001). Among patients receiving TR4AM flaps, fat necrosis developed in 10 smokers (26.3 percent), 2 ex-smokers (8.7 percent), and 17 nonsmokers (8.4 percent). Abdominal wall necrosis was more common in smokers (7.9 percent) than in ex-smokers (4.3 percent) or nonsmokers (1.0 percent). In this large series, tissue expansion was performed more often in smokers than was autogenous reconstruction. Complications were significantly more frequent in smokers. Mastectomy flap necrosis was significantly more frequent in smokers, regardless of the type of reconstruction. Breast reconstruction should be done with caution in smokers. Ex-smokers had complication rates similar to those of nonsmokers. Smokers undergoing reconstruction should be strongly urged to stop smoking at least 3 weeks before their surgery.     

The prominent mandibular angle: preoperative management, operative technique, and results in 42 patients

A prominent mandibular angle is considered to be unattractive in the Orient because it gives the face a square and muscular appearance. While described infrequently in the United States, this entity is commonly encountered in the Orient owing to different facial characteristics and different aesthetic sensibilities. We present a retrospective study of 42 female patients who presented requesting the reduction of a prominent mandibular angle for cosmetic reasons. We describe our approach, which utilizes formal planimetry, cephalometric tracings, and Panorex mandibular radiographs. We utilize the intraoral approach and use an oscillating saw to resect the predetermined segment of bone. In 18 of the 42 patients, we resected muscle as well. We also describe using the preauricular incision in a patient undergoing a concomitant rhytidectomy. Our cosmetic results have been generally satisfactory, with only one inaccurate osteotomy. We had three infections which resolved without sequelae.     

Indications for and results following exploration of the common bile duct for stones

Among 100 consecutive patients who had removal or drainage of the gallbladder and exploration of the common bile duct for stones, there were no serious, immediate or late complications and there were no operative deaths. Ninety-six of the 100 patients had stones in the gallbladder, in the common duct, or in both, and 52 of these patients had one or more stones in the common duct. Ten patients died subsequently of unrelated causes. Six patients were lost to followup. Of the 84 patients whose present condition is known, 75 or 89 per cent have had a completely satisfactory result. Six more patients have minor residual symptoms, and for them the result has been classified as good. In three patients, the results were unsatisfactory. Cholangiograms taken before the removal of the T-tube showed residual stones in two patients. In each instance, the stone or stones have been subsequently passed and both patients are in excellent condition.     

Large-scale,millennial-length temperature reconstructions from tree-rings

Over the past two decades, the dendroclimate community has produced various annually resolved, warm season temperature reconstructions for the extratropical Northern Hemisphere. Here we compare these tree-ring based reconstructions back to 831 CE and present a set of basic metrics to provide guidance for non-specialists on their interpretation and use. We specifically draw attention to (i) the imbalance between (numerous) short and (few) long site chronologies incorporated into the hemispheric means, (ii) the beneficial effects of including maximum latewood density chronologies in the recently published reconstructions, (iii) a decrease in reconstruction covariance prior to 1400 CE, and (iv) the varying amplitudes and trends of reconstructed temperatures over the past 1100 years. Whereas the reconstructions agree on several important features, such as warmth during medieval times and cooler temperatures in the 17th and 19th centuries, they still exhibit substantial differences during 13th and 14th centuries. We caution users who might consider combining the reconstructions through simple averaging that all reconstructions share some of the same underlying tree-ring data, and provide four recommendations to guide future efforts to better understand past millennium temperature variability.     

Malagasy primate origins: phylogenies, fossils, and biogeographic reconstructions

The geographic origin of Malagasy primates is a rich source of debate, providing a useful context for understanding effects of differing phylogenetic interpretations upon area of origin reconstructions. This study has evaluated the biogeographic implications of competing primate phylogenies in order to reconstruct the area of origin of Malagasy strepsirhines. The robusticity of biogeographic inference is examined based on sensitivity to tree topology. The results demonstrate extreme vulnerability to both out-group choice and internal tree topology, suggesting caution for area of origin interpretations from phylogenies that exclude fossil taxa. Moreover, even a single taxon can have a powerful effect upon biogeographic interpretations. Perhaps not surprisingly, it is only with greater phylogenetic resolution that a clearer understanding of the biogeographic origins of Malagasy primates will emerge.     

Otoplasty: anterior scoring technique and results in 500 cases

Corrective otoplasty is a commonly performed procedure to change the shape of the auricular cartilage. Many techniques use permanent sutures to maintain the cartilage folding, whereas other techniques rely on cartilage incisions (partial thickness or full thickness). At this institution, a cartilage cutting and anterior scoring technique has been used for more than 30 years with pleasing results. The surgical techniques published in the past have been reviewed and compared with the procedure used at this institution to point out the advantages, disadvantages, and differences of these various techniques. Also reviewed were 500 consecutive cases operated on under local or general anesthesia between January of 1993 and December of 1995 to determine the incidence of early and late complications. The patients were contacted by mail to return for a follow-up examination or answer a questionnaire, at least 2 years after the procedure. Early complications were bleeding in 13 cases (2.6 percent) and hematoma in 2 cases (0.4 percent). There were no infections or ear necrosis. A small cutaneous wound was present on the anterior skin in three patients (0.6 percent), and there was one wound dehiscence (0.2 percent). Late complications were keloids in two cases and inclusion cysts in three cases. Residual deformity was noted in 22 cases and asymmetry in 28 cases. Secondary surgery was performed in six cases. The questionnaire was answered by 387 patients (77.4 percent response rate): pain when the ear is touched was present in 22 cases (5.7 percent), hypesthesia in 15 cases (3.9 percent), occasional cutaneous irritation in 38 cases (9.8 percent), asymmetry in 71 cases (18.4 percent), and abnormal ear shape in 17 cases (4.4 percent). Twenty-nine patients (7.5 percent) also noted that the ear was more sensitive to cold or touch. The satisfaction rate was 94.8 percent: very satisfied, 74 percent; satisfied, 20.8 percent; dissatisfied, 4.2 percent; and very dissatisfied, 1 percent. These results were compared with other published series of complications and late results after otoplasty; the complication rates are similar or lower in this study. Therefore, it can be concluded that the cartilage cutting and anterior scoring technique otoplasty is a safe procedure with a high patient-parent-surgeon satisfaction rate.     

Evaluation of the results of arterial reconstructions supplemented by the creation of an arteriovenous anastomosis

Arterial reconstructions supplemented with arteriovenous anastomosis were studied experimentally. The ischemic changes in the operated dog limb were evaluated by various methods, including electronic diagnostic technique. When the diameter of arteriovenous anastomosis was equal to 40-60 per cent of arterial graft diameter, the best postoperative results were observed.     

Impact of normalisation,elicitation technique and background information on panel weighting results in life cycle assessment

Purpose

Weighting in Life Cycle Assessment (LCA) is a much-debated topic. Various tools have been used for weighting in LCA, Multi-Criteria Decision Analysis (MCDA) being one of the most common. However, it has not been thoroughly assessed how weight elicitation techniques of MCDA with different scales (interval and ratio) along with external and internal normalisation affect weighting and subsequent results. The aim of this survey is to compare different techniques in an illustrative example in the building sector.

Methods

A panel of Nordic LCA experts accomplished six weighting exercises. The different weight elicitation techniques are SWING which is based on the interval scale; Simple Multi-Attribute Rating Technique (SMART) and Analytic Hierarchy Process (AHP) which is based on the ratio scale. Information on the case study was provided for the panellists, along with characterised or normalised impact assessment scores. However, in the first weighting exercise, the panellists were not provided with any scores or background information, but they had to complete the weighting at a more general level. With the weights provided by the panel, the environmental impacts of three alternative house types were aggregated. The calculations were based on three well-grounded aggregation rules, which are commonly used in the field of LCA or decision analysis.

Results and discussion

In the illustrative construction example, the different aggregation rules had the biggest impact on the results. The results were different in the six calculation methods: when externally normalised scores were applied, house type A was superior in most of the calculations, but when internal normalisation was accomplished, house type C was superior. By using equal weights, similar results were obtained. None of the panellists intuitively considered A as the superior house type, but in some of the calculations, this was indeed the case. Furthermore, the results refer to the fact that the panellists completed the weighting on the basis of their general knowledge, without taking the features of different weight elicitation techniques into account.

Conclusions

External normalisation provides information on a magnitude of impacts, and in some cases, external normalisation may be a more influential factor than weighting. Based on the results, it cannot be stated which different weight elicitation technique is the most suitable for LCA. However, the method should be selected based on the aims and purpose of the study. Moreover, the elicitation questions should be explained with care to experts so that they interpret the questions as intended.