State of the Art in Phalloplasty

2005 ◽  
Vol 22 (3) ◽  
pp. 172-178 ◽  
Author(s):  
Alexander A. Krakovsky
Keyword(s):  
Patient Satisfaction ◽  
Sigmund Freud ◽  
Cosmetic Surgery ◽  
State Of The Art ◽  
Surgical Techniques ◽  
The United States ◽  
Assessment Scale ◽  
Medical Community ◽  
Penis Size ◽  
Image Assessment

Introduction: After Sigmund Freud “opened the bedroom door,” significant shifts in social attitudes, behaviors, and institutional regulations concerning male and female body images and the understanding of human sexuality began to occur. Today, male cosmetic genital enhancement surgery, or phalloplasty, has become the subject of recent surgical achievements that are gaining significant popularity in the United States and abroad. Appropriate methodology and surgical techniques have been developed to fulfill the demand in this field of cosmetic surgery. The objective of this study is to review the state of the art in phalloplasty and provide information about the availability of the techniques to the medical community and the public to inform them of surgical treatments that may improve unsatisfactory sexual performance, relationships, intimacy, and love by increasing the size of a man's penis. Material and Methods: Two surgeons performed phalloplasty on 594 patients at multiple surgical facilities over a 2-year period. Phalloplasty procedures include penile lengthening, penile girth enhancement, dual augmentation (combined lengthening and girth enhancement), penile glanular enhancement, scrotal web resection, and reconstruction. The patients' own satisfaction with the results of their surgeries was analyzed by using the Penis Image Assessment Scale Questionnaire. The assessment was based upon questions related to penis size, satisfaction of sexual experiences, and the psychological perspective of patients regarding their penises before and after phalloplasty. Results: Patient scores on the Penis Image Assessment Scale Questionnaire were higher before surgery (almost twice as high) than they were after surgery, showing an increase in patient satisfaction with penis size and performance after enhancement. Seventeen patients required subsequent surgery to treat local infection. Twenty-nine patients experienced localized swelling 3–7 days after surgery. The results showed enormous patient satisfaction with the cosmetic surgical procedures performed. Discussion: Penis size has always symbolized strength, virility, power, and domination in relationships. Although this subject was taboo some years ago, today many men are interested in learning about how phalloplasty may improve their self-confidence, sexual relationships, and female partners' satisfaction. Consequently, phalloplasty has acquired wide acceptance and tremendous popularity.

scholarly journals The WxChallenge: Forecasting Competition, Educational Tool, and Agent of Cultural Change

2013 ◽  
Vol 94 (10) ◽  
pp. 1501-1506 ◽  
Author(s):  
Bradley G. Illston ◽  
Jeffrey B. Basara ◽  
Christopher Weiss ◽  
Mike Voss
Keyword(s):  
Cultural Change ◽  
State Of The Art ◽  
Learning Experience ◽  
The United States ◽  
Higher Learning ◽  
Educational Tool ◽  
Web Interfaces ◽  
Wind Speeds ◽  
University Of Oklahoma ◽  
The University

The WxChallenge, a project developed at the University of Oklahoma, brings a state-of-the-art, fun, and exciting forecast contest to participants at colleges and universities across North America. The challenge is to forecast the maximum and minimum temperatures, precipitation, and maximum wind speeds for select locations across the United States over a 24-h prediction period. The WxChallenge is open to all undergraduate and graduate students, as well as higher-education faculty, staff, and alumni. Through the use of World Wide Web interfaces accessible by personal computers, tablet computer, and smartphones, the WxChallenge provides a state-of-the-art portal to aid participants in submitting forecasts and alleviate many of the administrative issues (e.g., tracking and scoring) faced by local managers and professors. Since its inception in 2006, 110 universities have participated in the contest and it has been utilized as part of the curricula for 140 classroom courses at various institutions. The inherently challenging nature of the WxChallenge has encouraged its adoption as an educational tool. As its popularity has grown, professors have seen the utility of the Wx-Challenge as a teaching aid and it has become an instructional resource of many meteorological classes at institutions for higher learning. In addition to evidence of educational impacts, the competition has already begun to leave a cultural and social mark on the meteorological learning experience.

Isolated meniscus injuries in skeletally immature children and adolescents: state of the art

2021 ◽  
pp. jisakos-2020-000496
Author(s):  
Gustavo Vinagre ◽  
Flávio Cruz ◽  
Khalid Alkhelaifi ◽  
Pieter D'Hooghe
Keyword(s):  
Children And Adolescents ◽  
State Of The Art ◽  
Surgical Techniques ◽  
Meniscal Repair ◽  
Management Plan ◽  
Anatomical Location ◽  
Return To Sports ◽  
Meniscal Tears ◽  
Geographical Differences ◽  
Meniscal Healing

The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.

scholarly journals Polyurethane-Coated Implants for Prevention of Double-Bubble Effect in Breast Augmentation

2021 ◽  
Vol 7 ◽  
pp. 2513826X2110289
Author(s):  
Vitali Bagirov
Keyword(s):  
United States ◽  
Breast Augmentation ◽  
Cosmetic Surgery ◽  
The United States ◽  
Treatment Result ◽  
Lower Pole ◽  
Common Complication ◽  
Breast Volume ◽  
Double Bubble ◽  
Growing Body

Breast augmentation is the most frequently performed cosmetic surgery in the United States, with approximately 279,000 patients every year. The so-called double-bubble effect (DBE) is a common complication in breast augmentation. This complication is characterized by folds running along the lower pole of the breast, forming distinct bubble-like protrusions above and below the fold. Factors that increase the risk of DBE include bulbous breasts and a large native breast volume. There is evidence that polyurethane-coated (PU) implants may help to reduce the risk of DBE. We describe here the case of a 47-year old patient for whom DBE has recurred in each of 4 tandem breast surgeries. PU implants ultimately appeared to prevent the DBE, leading to an aesthetically satisfying treatment result for the patient. This case adds weigh to the growing body of evidence that supports the use of polyurethane implants to prevent DBE.

Article Commentary: Defining New Directions for More Effective Management of Surgical Pain in the United States: Highlights of the Inaugural Surgical Pain Congress™

2014 ◽  
Vol 80 (3) ◽  
pp. 219-228 ◽  
Author(s):  
Girish P. Joshi ◽  
David E. Beck ◽  
Roger Hill Emerson ◽  
Thomas M. Halaszynski ◽  
Jonathan S. Jahr ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Best Practice ◽  
Task Force ◽  
Unmet Need ◽  
The United States ◽  
Cost Of Care ◽  
Inaugural Meeting ◽  
Surgical Pain ◽  
Wide Range

Despite advances in pharmacologic options for the management of surgical pain, there appears to have been little or no overall improvement over the last two decades in the level of pain experienced by patients. The importance of adequate and effective surgical pain management, however, is clear, because inadequate pain control 1) has a wide range of undesirable physiologic and immunologic effects; 2) is associated with poor surgical outcomes; 3) has increased probability of readmission; and 4) adversely affects the overall cost of care as well as patient satisfaction. There is a clear unmet need for a national surgical pain management consensus task force to raise awareness and develop best practice guidelines for improving surgical pain management, patient safety, patient satisfaction, rapid postsurgical recovery, and health economic outcomes. To comprehensively address this need, the multidisciplinary Surgical Pain Congress™ has been established. The inaugural meeting of this Congress (March 8 to 10, 2013, Celebration, Florida) evaluated the current surgical pain management paradigm and identified key components of best practices.

Meniscal transplantation: state of the art

2017 ◽  
Vol 2 (6) ◽  
pp. 339-349 ◽  
Author(s):  
Pablo E Gelber ◽  
Peter Verdonk ◽  
Alan M Getgood ◽  
Juan C Monllau
Keyword(s):  
State Of The Art ◽  
Surgical Techniques ◽  
Return To Sport ◽  
Reoperation Rate ◽  
Controversial Issues ◽  
Future Perspectives ◽  
Meniscal Allograft Transplantation ◽  
Meniscal Allograft ◽  
Feasible Option ◽  
Chondroprotective Effect

Meniscal resection is the most common surgical procedure in orthopaedics. When a large meniscal loss becomes clinically relevant, meniscal allograft transplantation (MAT) is a feasible option. However, although this technique has evolved since the ‘80s, there are still several controversial issues related to MAT. Most importantly, its chondroprotective effect is still not completely proven. Its relatively high complication and reoperation rate is another reason for this procedure not yet being universally accepted. Despite its controversial chondroprotective effect, nevertheless, MAT has become a successful treatment for pain localised in a previously meniscectomised knee, in terms of pain relief and knee function. We conducted a careful review of the literature, highlighting the most relevant studies in various aspects of this procedure. Precise indications, how it behaves biomechanically, surgical techniques, return to sport and future perspectives are among the most relevant topics that have been included in this state-of-the-art review.

The Under-Enrollment of HIV-infected Foster Children in Clinical Trials and Protocols and the Need for Corrective State Action

1994 ◽  
Vol 20 (3) ◽  
pp. 231-249
Author(s):  
Briar McNutt
Keyword(s):  
United States ◽  
New York ◽  
Hiv Infection ◽  
The United States ◽  
Hiv And Aids ◽  
Medical Community ◽  
State Action ◽  
Pediatric Aids ◽  
Control And Prevention ◽  
Year 2000

The incidence of HIV infection and AIDS in children has grown at an alarming rate. Approximately one million children worldwide have HIV infection. By the year 2000, an estimated ten million children will suffer from the disease. Currently, the United States has a population of an estimated 10,000 to 20,000 HIV-infected children. As of June 30, 1993, the Centers for Disease Control and Prevention (CDC) reported 4,710 known AIDS cases in children twelve years-old and younger. At that point, New York City reported 1,124 pediatric AIDS cases which represented twenty-four percent of all cases in the United States.With the rising number of HIV-infected children, the medical community in the United States has begun to search for HIV-and AIDS-related treatments particularized for children. In addition to establishing guidelines for HIV-infected children's frequent check-ups and timely immunizations, the medical community has initiated research studies involving HIV-infected children.

scholarly journals The origins and persistence of psychosurgery in the state of Iowa

2017 ◽  
Vol 43 (3) ◽  
pp. E8 ◽  
Author(s):  
Francis J. Jareczek ◽  
Marshall T. Holland ◽  
Matthew A. Howard ◽  
Timothy Walch ◽  
Taylor J. Abel
Keyword(s):  
United States ◽  
Mental Illness ◽  
The United States ◽  
State Mental Health ◽  
The State ◽  
Medical Community ◽  
State University ◽  
University Of Iowa ◽  
The University ◽  
Frontal Lobotomy

Neurosurgery for the treatment of psychological disorders has a checkered history in the United States. Prior to the advent of antipsychotic medications, individuals with severe mental illness were institutionalized and subjected to extreme therapies in an attempt to palliate their symptoms. Psychiatrist Walter Freeman first introduced psychosurgery, in the form of frontal lobotomy, as an intervention that could offer some hope to those patients in whom all other treatments had failed. Since that time, however, the use of psychosurgery in the United States has waxed and waned significantly, though literature describing its use is relatively sparse. In an effort to contribute to a better understanding of the evolution of psychosurgery, the authors describe the history of psychosurgery in the state of Iowa and particularly at the University of Iowa Department of Neurosurgery. An interesting aspect of psychosurgery at the University of Iowa is that these procedures have been nearly continuously active since Freeman introduced the lobotomy in the 1930s. Frontal lobotomies and transorbital leukotomies were performed by physicians in the state mental health institutions as well as by neurosurgeons at the University of Iowa Hospitals and Clinics (formerly known as the State University of Iowa Hospital). Though the early technique of frontal lobotomy quickly fell out of favor, the use of neurosurgery to treat select cases of intractable mental illness persisted as a collaborative treatment effort between psychiatrists and neurosurgeons at Iowa. Frontal lobotomies gave way to more targeted lesions such as anterior cingulotomies and to neuromodulation through deep brain stimulation. As knowledge of brain circuits and the pathophysiology underlying mental illness continues to grow, surgical intervention for psychiatric pathologies is likely to persist as a viable treatment option for select patients at the University of Iowa and in the larger medical community.

scholarly journals What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction.

2020 ◽  
Author(s):  
Pasquale Sansone ◽  
Luca Gregorio Giaccari ◽  
Mario Faenza ◽  
Pasquale Di Costanzo ◽  
Sara Izzo ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Breast Surgery ◽  
The United States ◽  
Measurement Properties ◽  
Anesthetic Techniques ◽  
Measurement Instruments ◽  
Health Measurement ◽  
Cosmin Checklist ◽  
Locoregional Anesthesia ◽  
Significant Difference

Abstract Background: Breast surgery in the United States is common. Pain affects up to 50% of women undergoing breast surgery and can interfere with postoperative outcomes. General anesthesia is the conventional, most frequently used anaesthetic technique. Various locoregional anesthetic techniques are also used for breast surgeries. A systematic review of the use of locoregional anesthesia for postoperative pain in breast surgery is needed to clarify its role in pain management.Objectives: To systematically review literature to establish the efficacy and the safety of locoregional anesthesia used in the treatment of pain after breast surgery.Methods: Embase, MEDLINE, Google Scholar and Cochrane Central Trials Register were systematically searched in Mars 2020 for studies examining locoregional anesthesia for management of pain in adults after breast surgery. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively.Results: Nineteen studies evaluating locoregional anesthesia were included: 1058 patients underwent lumpectomy/mastectomy, 142 breast augmentation and 79 breast reduction. Locoregional anesthesia provides effective anesthesia and analgesia in the perioperative setting, however no statistically significant difference emerged if compared to other techniques. For mastectomy only, the use of locoregional techniques reduces pain in the first hour after the end of the surgery if compared to other procedures (p = 0.02). Other potentially beneficial effects of locoregional anesthesia include decreased need for opioids, decreased postoperative nausea and vomiting, fewer complications and increased patient satisfaction. All this improves postoperative recovery and shortens hospitalization stay. In none of these cases, locoregional anesthesia was statistically superior to other techniques.Conclusion: The results of our review showed no differences between locoregional anesthesia and other techniques in the management of breast surgery. Locoregional techniques are superior in reducing pain in the first hour after mastectomy.

scholarly journals Modification of Combined Vibrated Power Assisted Liposuction with Periareolar Gland Excision in management of Gynecomastia

2018 ◽  
Vol 14 (1) ◽  
pp. 18-23
Author(s):  
Kurdo Akram Qradaghi
Keyword(s):  
Patient Satisfaction ◽  
Retrospective Study ◽  
Operative Time ◽  
Surgical Techniques ◽  
Satisfaction Rate ◽  
Areola Complex ◽  
Different Types ◽  
Aesthetic Results ◽  
The Mean ◽  
Patient Satisfaction Rate

Background: The recognized procedures that have been used to treat gynecomastia are said to have relatively a long operative time, less patient satisfaction rate, they are merely used, in mild to moderate gynecomastia, leaves a mild bulging over the nipple areola complex, resulting in aesthetically unsatisfactory results. The more the grade of gynecomastia, the more complicated the used surgical techniques. This study evaluates the success rate of these simplest surgical technique in higher grades of gynecomastia. Objectives: to present the experiences with use of Modification of Combined Vibrated Power Assisted Liposuction with Periareolar Gland Excision in management of in different type Gynecomastia Type of the study: This is a retrospective study Methods: The study  includes the use of a modification of combine vibrated power-assisted liposuction with periareolar gland excision applied for managing different types of gynecomastia. In 23 consecutive patients (46 breasts) treated between February of 2011 and March of 2016. Results: 23 patients (46 breasts) were successfully treated using this technique. Volume aspirated in both breast was 792 ml (range, 450 to 1600 ml). Using the periareolar excision technique, the mean operative time was 55 minutes (range, 45 to 90 minute). Complications were minimal (1.5 % per breasts), and no revisions were required. Conclusions: The modified Combined vibrated power assisted liposuction and the periareolartechnique have demonstrated to be a less time consuming versatileapproach, for the treatment of gynecomastia and consistently produces a smoothcontoured male breast, it is promising method to achieve good aesthetic results in gynecomastia surgerywhile resulting in an inconspicuous scar.

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