Lipoplasty of the calves and ankles

The author details his experience over the past 6 years with 53 patients who had lipoplasty of the calves and ankles. The patient selection and diagnosis are critical. Determining whether the problem is localized or circumferential (generalized) influences the approach. The incisions are outlined as well as the best technique to provide excellent access to the entire leg. Although the results take a considerable period of time to appear because of long-lasting edema, after 3 months in the localized cases and 6 months in the generalized cases, an excellent configuration of the lower leg may be obtained. The author has had no significant complications in this series.     

Male circumcision and sexually transmitted infections in Botswana

This study set out to investigate the influence of male circumcision and other factors on sexually transmitted infections in Botswana. A syndromic approach, which diagnoses a sexually transmitted infection based on the presence of urethral discharge or genital ulcers rather than on laboratory tests, was used. The data were from the 2001 Botswana AIDS Impact Survey where a nationally representative, randomly selected sample of men and women aged 10-64 years were interviewed in both urban and rural areas. The sample selected for this study consisted of 216,480 men aged 15-64 years who had ever had sexual intercourse. The logistic regression technique was executed to examine the association between male circumcision and self-reported urethral discharge or genital ulcers, while controlling for all other independent variables in the analysis. The main finding of this study was that among men who are circumcised, the odds for self-reported urethral discharge or genital ulcers are significantly lower than for those men who are not circumcised in both urban and rural Botswana. The analysis also showed that the odds in favour of self-reported urethral discharge or genital ulcers, for men who drink alcohol, are twice as large as those for men who do not drink alcohol, controlling for all other independent variables in the analysis. Religion and ethnicity also came through as factors exerting a protective influence against self-reported symptoms of sexually transmitted infections. The conclusion is that while male circumcision appears to be significantly associated with the risk for self-reported urethral discharge or genital ulcers, it is man's behaviour, irrespective of ethnicity or religious dictates, that continues to play a vital role in protection against self-reported symptoms of sexually transmitted infections in Botswana.     

Brow suspension,a minimally invasive technique in facial rejuvenation

People tend to prefer noninvasive or minimally invasive methods of facial rejuvenation, especially when it involves their face, which is the hallmark of a person's identity and impossible to hide. It is widely known that brow ptosis gives the face a "tired look" and also accentuates deformities of the upper eyelid. Most people who are interested in facial rejuvenation may not accept even a minor surgery, such as an endoscopic surgery. The senior author has developed a minimally invasive method of suspending the brow at a higher position. In this technique, there is neither surgical dissection nor a surgical incision except for four stab incisions and suture insertion, which is why we refer to it as a nonsurgical brow suspension. It is done under local anesthesia, and the brows are fixed in the position that they assume when the patient is supine. In the past 6 years, we performed 387 brow suspensions on 324 female and 63 male patients. The youngest patient was 19 years old, and the oldest was 74 years old. A retrospective chart review was done. These 387 cases were reviewed by comparison of preoperative and postoperative photographs. This approach was not only used for patients who were not interested in surgical rejuvenation but was also combined with lipofilling, laser resurfacing, and/or upper blepharoplasty. This technique is useful for correcting postsurgical brow asymmetry. We present this technique as an adjunct to the established techniques of facial rejuvenation. Despite the high patient acceptance and technical ease, it is not a replacement for the established techniques of facial rejuvenation.     

Learning outcomes and student-perceived value of clay modeling and cat dissection in undergraduate human anatomy and physiology

Alternatives and/or supplements to animal dissection are being explored by educators of human anatomy at different academic levels. Clay modeling is one such alternative that provides a kinesthetic, three-dimensional, constructive, and sensory approach to learning human anatomy. The present study compared two laboratory techniques, clay modeling of human anatomy and dissection of preserved cat specimens, in the instruction of muscles, peripheral nerves, and blood vessels. Specifically, we examined the effect of each technique on student performance on low-order and high-order questions related to each body system as well as the student-perceived value of each technique. Students who modeled anatomic structures in clay scored significantly higher on low-order questions related to peripheral nerves; scores were comparable between groups for high-order questions on peripheral nerves and for questions on muscles and blood vessels. Likert-scale surveys were used to measure student responses to statements about each laboratory technique. A significantly greater percentage of students in the clay modeling group "agreed" or "strongly agreed" with positive statements about their respective technique. These results indicate that clay modeling and cat dissection are equally effective in achieving student learning outcomes for certain systems in undergraduate human anatomy. Furthermore, clay modeling appears to be the preferred technique based on students' subjective perceptions of value to their learning experience.     

Management of variceal haemorrhage.

Fig 2 gives an algorithm for the treatment of bleeding oesophageal varices. Initial resuscitation of the patient is of paramount importance, ideally followed by early interventional endoscopy. Recent advances in available endoscopic techniques enable the endoscopist to suit the therapeutic approach to the clinical situation. Injection sclerotherapy remains the initial treatment of choice in bleeding patients. Endoscopic banding ligation is an alternative, best used in patients who have spontaneously stopped bleeding or as a complementary treatment a few days after the initial session of injection sclerotherapy. The tissue adhesives and thrombin can be used to treat bleeding gastric varices. [table: see text] Should the endoscopic expertise not be available, drug treatment (with somatostatin or octreotide) or balloon tamponade are the treatments of choice. Transjugular intrahepatic portal-systemic stent shunt is a new effective technique, not yet widely available, which has a documented complication rate that has yet to be fully defined. It is a good alternative to surgery as a "rescue" procedure for patients who continue to bleed despite two sessions of endoscopic intervention.     

The use Of hypnotism As an Ethnologic research Technique

Abstract

A new approach in ethnographic fieldwork is the use of hypnotism, Induced regressionis felt to be especiallyhelpful to the investigator in distinguishing the real from the ideal in a given social context. Preferred subjects are those who participate in a tradition of ceremonialism. The authoritarian role of the investigator is stressed as a means of standardizing the technique and maintaining cooperation, Hypnosis may also be useful in cert in studies of linguistics and physical anthropology.     

Radiologic investigation of suspected extrahepatic biliary obstruction.

Data for 94 patients clinically suspected of having extrahepatic biliary obstruction who were referred for radiologic investigations were studied to compare the value of various imaging modalities used to detect this condition. Computed tomography emerged as the best indirect, noninvasive technique and percutaneous transhepatic cholangiography as the best direct technique. A standard approach to investigating suspected extrahepatic biliary obstruction is suggested that takes into consideration the interventional radiologic techniques currently used to treat this condition.     

Non-directive psychotherapy

Psychotherapy is a word to describe an age-old process. It would be better not to speak of psychotherapy, but of psychotherapies. Specialists are not the only ones who act as psychotherapists, since every human being fills this role at one time or another. Besides this, no two persons follow an identical approach. Finally, all therapists change technique constantly. The kinds of psychotherapy must therefore approach infinity.Some physicians appear to assume that only one type of psychotherapy may claim a scientific basis. Although Freud first put psychotherapy on a scientific path, there is no reason to say that Freud must be the last in this field. Over the past few years a new trend has started in psychotherapy which deserves close study. This new trend challenges some old beliefs and gives a new tool to help patients of some types. It is called non-directive or client-centered psychotherapy. This therapy does not try to solve the patient's problems for him, but rather establishes the conditions under which a patient can work out his own salvation. Each year non-directive psychotherapy grows in importance. Much can be learned from the method.     

NON-DIRECTIVE PSYCHOTHERAPY

Psychotherapy is a word to describe an age-old process. It would be better not to speak of psychotherapy, but of psychotherapies. Specialists are not the only ones who act as psychotherapists, since every human being fills this role at one time or another. Besides this, no two persons follow an identical approach. Finally, all therapists change technique constantly. The kinds of psychotherapy must therefore approach infinity.Some physicians appear to assume that only one type of psychotherapy may claim a scientific basis. Although Freud first put psychotherapy on a scientific path, there is no reason to say that Freud must be the last in this field.Over the past few years a new trend has started in psychotherapy which deserves close study. This new trend challenges some old beliefs and gives a new tool to help patients of some types. It is called non-directive or client-centered psychotherapy. This therapy does not try to solve the patient''s problems for him, but rather establishes the conditions under which a patient can work out his own salvation.Each year non-directive psychotherapy grows in importance. Much can be learned from the method.     

Optimizing body contour in massive weight loss patients: the modified vertical abdominoplasty

In morbid obesity, contour deformities of the abdomen are common after bariatric surgery and radical weight loss. Traditional abdominoplasty techniques often fail to maximally improve body contour in these cases because adjacent sites such as the hip rolls and flanks are not treated, leaving the patient with large lateral tissue redundancies and dog-ears. In an attempt to solve these challenging problems, the authors present the modified vertical abdominoplasty technique, a single-stage procedure that involves a combined vertical and transverse approach in which an "en bloc" resection of the redundant tissues is performed without undermining, drainage, or reinforcement of the abdominal wall. The latter is only carried out when diastasis and/or hernias are present, and Marlex mesh may be utilized when indicated. In patients with simultaneous large umbilical hernias and/or excessively long stalks, neoumbilicoplasty is recommended. A significant improvement of abdominal contour was obtained in the vast majority of patients because the resection design offers simultaneous treatment of both vertical and transverse tissue redundancies in the abdomen and neighboring regions, with more harmonic results when compared with purely vertical or transverse approaches. The modified vertical abdominoplasty technique is an easy, fast, and reliable alternative for treating these patients, with less intraoperative bleeding, reduced overall cost, and low morbidity rates. In selected cases, the technique is capable of offering excellent results in terms of contouring and maximizes the overall outcome of treatment protocols for these patients, who can then be integrated into normal life with heightened self-esteem, happiness, and productivity.     

Transumbilical endoscopic breast augmentation: submammary and subpectoral

Endoscopic techniques have recently been applied to aesthetic cosmetic surgery procedures. Endoscopic bilateral augmentation mammaplasty through a transumbilical approach ("TUBA") has recently been advocated as an alternative technique. The purpose of this article is to describe the author's transumbilical technique, to identify procedural limitations and special considerations, and to retrospectively analyze preliminary results. Five hundred thirteen patients (n = 1026 breasts) who underwent submammary transumbilical augmentation from January of 1993 through December of 1998 were evaluated. In 1997, the technique was further developed to permit subpectoral placement of implants; an additional 140 patients (n = 280 breasts) who underwent subpectoral transumbilical augmentation from September of 1997 through February of 1999 will also be presented. Success of the technique was based upon a number of criteria, including completion of the operation without conversion to an inframammary incision or reoperation, normal nipple-areola sensation, absence of hematoma formation, absence of infection, no umbilical scar revision, and patient satisfaction. Complications included hematoma (n = 2 breasts), conversion to inframammary incision (n = 5 breasts), and required secondary corrective procedure (n = 3 breasts). The majority of these complications occurred early in the learning curve. The successful augmentation rate in 1306 breasts was 99.2 percent. Based upon these results, transumbilical endoscopic breast augmentation is believed to be a safe alternative technique with excellent results.     

Fluorescence-based analysis of the intracytoplasmic membranes of type I methanotrophs

Most methanotrophic bacteria maintain intracytoplasmic membranes which house the methane-oxidizing enzyme, particulate methane monooxygenase. Previous studies have primarily used transmission electron microscopy or cryo-electron microscopy to look at the structure of these membranes or lipid extraction methods to determine the per cent of cell dry weight composed of lipids. We show an alternative approach using lipophilic membrane probes and other fluorescent dyes to assess the extent of intracytoplasmic membrane formation in living cells. This fluorescence method is sensitive enough to show not only the characteristic shift in intracytoplasmic membrane formation that is present when methanotrophs are grown with or without copper, but also differences in intracytoplasmic membrane levels at intermediate copper concentrations. This technique can also be employed to monitor dynamic intracytoplasmic membrane changes in the same cell in real time under changing growth conditions. We anticipate that this approach will be of use to researchers wishing to visualize intracytoplasmic membranes who may not have access to electron microscopes. It will also have the capability to relate membrane changes in individual living cells to other measurements by fluorescence labelling or other single-cell analysis methods.     

Multivariate geometry as an approach to algal community analysis

Multivariate analyses are put in the context of more usual approaches to phycological investigations. The intuitive common-sense involved in methods of ordination, classification and discrimination are emphasised by simple geometric accounts which avoid jargon and matrix algebra. Warnings are given that artifacts result from technique abuses by the naive or over-enthusiastic. An analysis of a simple periphyton data set is presented as an example of the approach. Suggestions are made as to situations in phycological investigations, where the techniques could be appropriate. The discipline is reprimanded for its neglect of the multivariate approach.     

Transaxillary subpectoral augmentation in the ptotic breast: augmentation by disruption of the extended pectoral fascia and parenchymal sweep

A new approach to transaxillary subpectoral breast augmentation based on an understanding of the anatomy of the extended pectoral fascia and the inframammary fold allows for the widespread application of this technique. Previous authors have stated that transaxillary augmentation is only applicable to a small subset of the general population and is contraindicated in mild degrees of ptosis or in large augmentations. The new approach, augmentation by disruption of the extended pectoral fascia technique and the parenchymal sweep maneuver, prevents high-riding implants and double folds. By disrupting the fascia, the lower portion of the implant is able to sit in a partially subglandular rather than subfascial plane. The anatomy and clinical implications of the extended pectoral fascia are discussed, as is the augmentation by disruption of the extended pectoral fascia technique. The parenchymal sweep maneuver is also described. Clinical cases are presented.     

Lamellar split osteotomy: a new craniofacial technique

Craniofacial osteotomies have by convention been bilamellar translocations of the entire substance of the dysmorphic bone. This approach limits the surgeon by reducing the stable bone mass available for fixation, creating dependence on concave surfaces. Most important, it changes the bony topography that determines the preoperative plan. This paper presents a new craniofacial concept and technique used in 26 patients with various dysmorphic syndromes who were reconstructed by performing a lamellar split osteotomy. This technique maintains the internal lamella in its native position, thereby allowing it to act as a reference for the bony topography and providing a stable facial framework for rigid fixation. This interlamellar osteotomy has led to improved aesthetic results in the orthomorphic reconstructions of congenital and other deformities. It can be used in any aesthetic patient in whom contour changes or augmentation of form is desired. It is recommended as a preferred method for achieving quantitative contour improvement in patients over 3 years of age.     

Scars of experience: the art of moxibustion in Japanese Medicine and Society

Beliefs and practices surrounding moxibustion, a cautery technique used in Japan, are analyzed to demonstrate that the concept of holism is culture-bound and that the practice of East Asian medicine is often reductionistic.Pluralistic traditional medical belief systems of historical and contemporary Japan are discussed with reference to moxibustion. Moxa is used in popular family medicine, for ritual purification, as a technique to cure disease or as part of a holistic approach to healing; its symbolic meaning changes according to its usage and it serves to unite disparate medical beliefs.Socialization practices concerning attitudes towards illness reflect pluralistic values derived from traditional medical systems. One dominant set of values encourages patient and family responsibility during the healing process, adaptation to psychosocial relationships regarded as causal in disease occurrence and avoidance of verbal analysis of problems. These concepts, fundamental to East Asian medicine, cannot be readily adapted in the West as part of a holistic approach to health care.     

Moral dilemmas in (not) treating patients who feel they are a burden

Working as clinical ethicists in an academic hospital, we find that practitioners tend to take a principle‐based approach to moral dilemmas when it comes to (not) treating patients who feel like a burden, in which respect for autonomy tends to trump other principles. We argue that this approach insufficiently deals with the moral doubts of professionals with regard to feeling that you are a burden as a motive to decline or withdraw from treatment. Neither does it take into adequately account the specific needs of the patient that might underlie their feeling of being a burden to others. We propose a care ethics approach as an alternative. It focuses on being attentive and responsive to the caring needs of those involved in the care process—which can be much more specific than either receiving or withdrawing from treatment. This approach considers these needs in the context of the patient's identity, biography and relationships, and regards autonomy as relational rather than as individual. We illustrate the difference between these two approaches by means of the case of Mrs K. Furthermore, we show that a care ethics approach is in line with interventions that are found to alleviate feeling a burden and maintain that facilitating moral case deliberation among practitioners can supports them in taking a care ethics approach to moral dilemmas in (not) treating patients who feel like a burden.     

Patient-guided peripheral nerve exploration for the management of chronic localized pain

This technique represents a surgical adjunct for the management of chronic, localized pain in patients who continue to have pain despite exhaustive prior evaluation and treatment. The patient-guided approach was used in 10 patients referred with "intractable pain" and yielded good to excellent results in all but one patient. When applied selectively to cases with significantly distorted anatomy or previous failed interventions, this simple technique can minimize dissection and unnecessary resection, while offering relief to a patient population otherwise resigned to a life with chronic pain. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.     

Assessment of sera for chromatin-immunoprecipitation

Chromatin-immunoprecipitation (ChIP) is a powerful technique for mapping the protein-DNA interactions that occur in living cells. The critical technical determinant for successful ChIP is the availability of an appropriate, "ChIP-grade" serum. Here we present a technique designed to assess whether sera are suitable for ChIP, and to quantify their efficiency relative to a positive internal reference. This approach is useful as a first step toward ChIP-on-chip or ChIP-sequencing, especially in the case of recently identified proteins for which no binding sites are yet known.     

Implant therapy alternatives for geriatric edentulous patients

The predicament of being both elderly and edentulous undermines life quality for both patient and dentist. The former suffer because of morphological and functional compromises, the latter because of a dearth of safe and predictably successful clinical techniques. The introduction of the osseointegration technique suggested great promise for profoundly changing this predicament, but the specific merits of this approach have been mainly extrapolated ones. The purpose of this study was to examine the clinical success of treatment with osseointegration for patients who were 65 or older at the time of implant insertion. A second group of patients, who became 65 during the course of the study was also studied and the results recorded separately. Data regarding the longevity of implants and prosthodontic restorations and the numbers and types of problems encountered were recorded. The evidence suggests that the biological anchorage of tooth root analogues in elderly jaws is predicatbly successful and enhances the quality of life for geriatric patients who are edentulous.