Otosclerosis is a congenital or spontaneous-onset disease characterized by abnormal bone remodeling in the inner ear. Often this causes the stapes to adhere to the oval window, which impedes its ability to conduct sound, and is a cause of conductive hearing loss. Clinical otosclerosis is found in about 1% of people, although it is more common in forms that do not cause noticeable hearing loss. Otosclerosis is more likely in young age groups, and females. Two common treatments are stapedectomy, the surgical removal of the stapes and replacement with an artificial prosthesis, and stapedotomy, the creation of a small hole in the base of the stapes followed by the insertion of an artificial prosthesis into that hole.
Clinical relevance
Stapes
Stapes | Clinical relevance
It is the surgical removal of the stapes and replacement with an artificial prosthesis The stapes bone is removed and replaced with a micro prosthesis. It is the surgical removal of the stapes and replacement with an artificial prosthesis The surgical removal of the stapes and replacement with an artificial prosthesis.
what are the 3 smallest bones in the human body
user
Strapes is one of them
assistant
what is the size of this above bone?
user
Roughly 3 x 2.5mm
assistant
which part of the body is this located?
user
Middle ear of humans
assistant
besides the human, is this bony structure present in other living species in the animal kingdom?
user
It is one of three ossicles in mammals, in non-mammalian four-legged animals its homologous form is called the columella
assistant
what are the functions this bony structure serves?
user
It transmits sound vibrations from the incus to the oval window, a membrane-covered opening to the inner ear.
assistant
are there any variations of this bony structure?
user
It appears to be relatively constant in size in different ethnic groups
assistant
can this bony structure get affected or impaired?
user
Yes, its impairment causes conductive hearing loss
assistant
is there any remedy to solve this?
user
Two common treatments are stapedectomy and stapedotomy
assistant
how is the first treatment that you mentioned - carried out?
user
The world's first stapedectomy is credited to Dr. John J.Shea Jr. who performed it in May 1956 on a 54-year-old housewife who could no longer hear even with a hearing aid. Significant contributions to modern stapedectomy techniques were then made by the late Dr. Antonio De La Cruz of the House Ear Institute in Los Angeles; by the late Professor Henri André Martin of the Hôpital Edouard Herriot in Lyon, France, including calibrated platinotomy (stapes footplate rather than whole surgery) and trans-footplate piston surgery that also paved the way for modern stapedotomy; and by the late Dr. Jean-René Causse of the eponymous clinic in Béziers, France, who pioneered the use of Teflon piston prostheses (also critical progress for stapedotomy) and, with his late son Dr.
Stapedectomy | History
A modified stapes operation, called a stapedotomy, is thought by many otologic surgeons to be safer and reduce the chances of postoperative complications. In stapedotomy, instead of removing the whole stapes footplate, a tiny hole is made in the footplate - either with a microdrill or with a laser, and a prosthesis is placed to touch this area, oval window. This procedure can be further improved by the use of a tissue graft seal of the fenestra, which is now common practice. Laser stapedotomy is a well-established surgical technique for treating conductive hearing loss due to otosclerosis. The procedure creates a tiny opening in the stapes (the smallest bone in the human body) in which to secure a prosthetic.
Stapedectomy | Stapedotomy
John Joseph Shea Jr. (September 4, 1924 – February 8, 2015) was an American medical doctor, professor and surgeon. He attended Christian Brothers High School, Memphis, Tennessee, the University of Notre Dame and Harvard Medical School. He performed the first successful reconstructive stapedectomy in May, 1956. The patient was a 54-year-old housewife with conductive hearing loss so severe that she could no longer hear at all, even with a hearing aid. Shea removed the stapes, covered the oval window opening with a vein graft removed from the back of the patient's hand, and inserted a prosthesis to replace the diseased stapes bone.
John J. Shea Jr. | Introduction
Jean-Bernard Causse, the reattachment of the stapedius muscle alongside the use of veinous grafts.
Stapedectomy | History
There are various methods to treat otosclerosis. However the method of choice is a procedure known as stapedectomy. Early attempts at hearing restoration via the simple freeing of the stapes from its sclerotic attachments to the oval window were met with temporary improvement in hearing, but the conductive hearing loss would almost always recur. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear. A modern variant of this surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis.
Otosclerosis | Surgery
The stapes is commonly described as having been discovered by the professor Giovanni Filippo Ingrassia in 1546 at the University of Naples, although this remains the nature of some controversy, as Ingrassia's description was published posthumously in his 1603 anatomical commentary '. Spanish anatomist Pedro Jimeno is first to have been credited with a published description, in ' (1549). The bone is so-named because of its resemblance to a stirrup (), an example of a late Latin word, probably created in mediaeval times from "to stand" (), as stirrups did not exist in the early Latin-speaking world.
Stapes | History
A stapedectomy is a surgical procedure of the middle ear performed in order to improve hearing. If the stapes footplate is fixed in position, rather than being normally mobile, then a conductive hearing loss results. There are two major causes of stapes fixation. The first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes. In both of these situations, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis - a stapedectomy, or creating a small hole in the fixed stapes footplate and inserting a tiny, piston-like prosthesis - a stapedotomy.
Stapedectomy | Introduction
The revival of the stapes mobilization operation by Rosen, in 1953, made the use of the microscope mandatory, although it was not used by the originators of the technique, Kessel (1878), Boucheron (1888) and Miot (1890). Mastoidectomies began to be performed with the surgical microscope and so were the tympanoplasty techniques that became known in the early 1950s. The stapes mobilization operation had varying results and was soon replaced by stapedectomy, first described by John Shea, Jr.; this was an operation that was always performed with the microscope. Today neurosurgeons are very proud to use microscopes in their procedures. But it was not always so: many prestigious centers did not accept that idea and it had to be developed in relative isolation.
Microsurgery | History
Surgery may be complicated by a persistent stapedial artery, fibrosis-related damage to the base of the bone, or obliterative otosclerosis, resulting in obliteration of the base.
Stapes | Clinical relevance
Otosclerosis is a congenital or spontaneous-onset disease characterized by abnormal bone remodeling in the inner ear. Often this causes the stapes to adhere to the oval window, which impedes its ability to conduct sound, and is a cause of conductive hearing loss. Clinical otosclerosis is found in about 1% of people, although it is more common in forms that do not cause noticeable hearing loss. Otosclerosis is more likely in young age groups, and females. Two common treatments are stapedectomy, the surgical removal of the stapes and replacement with an artificial prosthesis, and stapedotomy, the creation of a small hole in the base of the stapes followed by the insertion of an artificial prosthesis into that hole.
Stapes | Clinical relevance
The stapes develops from the second pharyngeal arch during the sixth to eighth week of embryological life. The central cavity of the stapes, the obturator foramen, is due to the presence embryologically of the stapedial artery, which usually regresses in humans during normal development.
Stapes | Development
A much more detailed description of the first two ossicles followed in Andreas Vesalius' "De humani corporis fabrica" in which he devoted a chapter to them. Vesalius was the first to compare the second element of the ossicles to an anvil although he offered the molar as an alternative comparison for its shape. The first published description of the stapes came in Pedro Jimeno's "Dialogus de re medica" (1549) although it had been previously described in public lectures by Giovanni Filippo Ingrassia at the University of Naples as early as 1546. The term "ossicle" derives from , a diminutive of "bone" (; genitive ).
Ossicles | History
The results of this surgery are generally most reliable in patients whose stapes has lost mobility because of otosclerosis. Nine out of ten patients who undergo the procedure will come out with significantly improved hearing while less than 1% will experience worsened hearing acuity or deafness. Successful surgery usually provides an increase in hearing acuity of about 20 dB. That is as much difference as having your hands over both ears, or not. However, most of the published results of success fall within the speech frequency of 500 Hz, 1000 Hz and 2000 Hz; poorer results are typically obtained in the high frequencies, but these are normally less hampered by otosclerosis in the first place.
Stapedectomy | Introduction
Comparisons have shown stapedotomy to yield either as good or better results than stapedectomy (measured by hearing improvement and reduction in the air-bone hearing gap, and especially at higher sound frequencies), and to be less prone to complications. In particular, stapedotomy procedure greatly reduces the chance of a perilymph fistula (leakage of cochlear fluid). Stapedotomy, like stapedectomy, can be successful in the presence of sclerotic adhesions (tissue growths abnormally linking the bones to the tympanic cavity), provided the adhesions are removed during surgery. However, the adhesions may recur over time. The stapedotomy method is not applicable in those relatively rare cases that involve scleroris of the entire ossicular chain.
Stapedectomy | Stapedectomy vs. stapedotomy
In 1521, Berengario da Carpi performed the first surgical treatment for prolapse. This was to tie a rope around the prolapse, tighten it for two days until it was no longer viable and cut it off. Wine, aloe, and honey were then applied to the stump.
Vaginal anomalies | History
All those definitions are descriptive, but morphologically vacuous. In contrast, a professional botanical publication puts the matter plainly in a key to "Eriogonum": "Scapes (the first internode)... Botanically, any such structure is practically of necessity an internode".
Scape (botany) | Practical definition
The antibiotic, streptomycin was discovered in the U.S.A. in 1942. It enabled previously ill patients to be made fit for surgery. The first patient to receive streptomycin in Scotland, was author and journalist, George Orwell. Orwell was admitted to Hairmyres on Christmas Eve 1946. At the time of his admission he was writing his novel Nineteen Eighty-Four. The staff, insisting that complete physical and mental rest was essential for effective treatment, confiscated his typewriter. With rest, his health improved to some extent but attempts to rest his badly affected lung by simple surgical procedures were not successful. He suffered severe side effects from his treatment, and although the disease was responding, it had to be stopped after fifty days.
University Hospital Hairmyres | Second World War
The first stage of treatment used to be a reversible colostomy. In this approach, the healthy end of the large intestine is cut and attached to an opening created on the front of the abdomen. The contents of the bowel are discharged through the hole in the abdomen and into a bag. Later, when the patient's weight, age, and condition are right, the "new" functional end of the bowel is connected with the anus. The first surgical treatment involving surgical resection followed by reanastomosis without a colostomy occurred as early as 1933 by Doctor Baird in Birmingham on a one-year-old boy.
Hirschsprung's disease | Colostomy
If the periosteum or underlying muscles (frontalis, occipitalis, temporalis) are intact, secondary closure by granulation is possible. Before surgical intervention this was the only option available, as used to treat Robert McGee in 1864. Considering modern aesthetic standards, a better option is the use of split-thickness or full-thickness skin grafts, which is also quicker. When bulk is needed for a better contour a free flap is used, or as shown in the pictures, a regional flap.
Scalp reconstruction | Soft tissue defects
Complications of stapedectomy: When a stapedectomy is done in a middle ear with a congenitally fixed footplate, the results may be excellent but the risk of hearing damage is greater than when the stapes bone is removed and replaced (for otosclerosis). This is primarily due to the risk of additional anomalies being present in the congenitally abnormal ear. If high pressure within the fluid compartment that lies just below the stapes footplate exists, then a perilymphatic gusher may occur when the stapes is removed. Even without immediate complications during surgery, there is always concern of a perilymph fistula forming postoperatively.
Stapedectomy | Complications
This procedure was first described by an Italian surgeon – Dr. Antonio Longo, Department of Surgery, University of Palermo – in 1993 and since then has been widely adopted through Europe. This procedure avoids the need for wounds in the sensitive perianal area and, as a result, has the advantage of significantly reducing the patient's post operative pain. Follow-up on relief of symptoms indicate a similar success rate to that achieved by conventional haemorrhoidectomy. Since PPH was first introduced it has been the subject of numerous clinical trials and in 2003 the National Institute of Clinical Evidence (NICE) in the UK issued full guidance on the procedure stating it was safe and efficacious.
Stapled hemorrhoidopexy | Development
Simple behavioral methods are recommended as initial treatment. Other treatment methods include the following:
Nocturnal enuresis | Treatment approaches
The first recorded attempt at repairing the tympanic membrane was made by Marcus Banzer in 1640 using an ivory tube covered by pig's bladder.
Tympanoplasty | History
The first recorded successful appendectomy was on December 6, 1735, at St. George's Hospital in London, when French surgeon Claudius Amyand described the presence of a perforated appendix within the inguinal hernial sac of an 11-year-old boy. The organ had apparently been perforated by a pin the boy had swallowed. The patient, Hanvil Andersen, made a recovery and was discharged a month later. Harry Hancock performed the first abdominal surgery for appendicitis in 1848, but he did not remove the appendix. In 1889 in New York City, Charles McBurney described the presentation and pathogenesis of appendicitis accurately and developed the teaching that an early appendectomy was the best treatment to avoid perforation and peritonitis.
Appendectomy | History
In 1995, Glasscock et al. published a 25-year single-centre review of over 900 patients who underwent stapedectomy and stapedotomy and found complications rates as follows: reparative granuloma 1.3%, tympanic membrane perforation 1.0%, total sensorineural hearing loss 0.6%, partial sensorineural hearing loss 0.3%, and vertigo 0.3%. In this series, there was no incidence of facial nerve paralysis or tinnitus.
Stapedectomy | Complications
As the century progressed, some surgical interventions, including the pneumothorax or plombage technique—collapsing an infected lung to "rest" it and allow the lesions to heal—were used to treat tuberculosis. Pneumothorax was not a new technique by any means. In 1696, Giorgio Baglivi reported a general improvement in tuberculosis sufferers after they received sword wounds to the chest. F.H. Ramadge induced the first successful therapeutic pneumothorax in 1834, and reported subsequently the patient was cured. It was in the 20th century, however, that scientists sought to rigorously investigate the effectiveness of such procedures. In 1939, the "British Journal of Tuberculosis" published a study by Oli Hjaltested and Kjeld Törning on 191 patients undergoing the procedure between 1925 and 1931; in 1951, Roger Mitchell published several articles on the therapeutic outcomes of 557 patients treated between 1930 and 1939 at Trudeau Sanatorium in Saranac Lake.
History of tuberculosis | Treatments
On his advice the first splenectomy for haemolytic jaundice was carried out in Florence in 1903.
Guido Banti | Work
In addition to identifying drapetomania, Cartwright prescribed a remedy. His feeling was that with "proper medical advice, strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented". As a remedy for this "disease", doctors made running a physical impossibility by prescribing the removal of both big toes. In the case of slaves "sulky and dissatisfied without cause"–a warning sign of imminent flight–Cartwright prescribed "whipping the devil out of them" as a "preventative measure".
Drapetomania | Prevention and remedy
Other treatments include rituximab infusion or self-injection with Interferon-alpha. In limited cases, the person may benefit from "splenectomy" (removal of the spleen). These treatments are not typically given as the first treatment because their success rates are lower than cladribine or pentostatin.
Leukemia | Hairy cell
The endarterectomy procedure was developed and first done by the Portuguese surgeon Joao Cid dos Santos in 1946, when he operated an occluded superficial femoral artery, at the University of Lisbon. In 1951 an Argentinian surgeon repaired a carotid artery occlusion using a bypass procedure. The first endarterectomy was successfully performed by Michael DeBakey around 1953, at the Methodist Hospital in Houston, TX, although the technique was not reported in the medical literature until 1975. The first case to be recorded in the medical literature was in The Lancet in 1954; the surgeon was Felix Eastcott, a consultant surgeon and deputy director of the surgical unit at St Mary's Hospital, London, UK.
Carotid endarterectomy | History
He performed the longitudinal incision, relieving the obstruction, but found that the sutures tore out through the muscle when he attempted to close the incision. He elected to cover the defect with an omental patch, realising that it was not necessary to suture the pyloric muscle. This procedure, incising the pyloric muscle while leaving the mucosa intact and leaving the muscle to heal, was the first pyloromyotomy to be performed and became known as Ramstedt's operation. Ramstedt performed a second pyloromyotomy in 1912, and did not use an omental patch on the second occasion. Both children recovered well, and Ramstedt reported the new procedure in September 1912.
Conrad Ramstedt | Ramstedt's operation
There, he was the first to demonstrate physiologically that the innervation of the tensor tympani muscle was by the trigeminal nerve and that the innervation of the stapedial muscle was by the facial nerve. In another series of experiments, Politzer connected two manometers, one placed in the external auditory canal meatus and another in the pharynx, in order to study air movements through the Eustachian tube. In 1861, he published his first results on a new technique based on this knowledge, to treat internal ear diseases by insufflating the middle ear through the Eustachian tube, which obviated the need of its catheterization.
Ádám Politzer | Life
Most hydroceles appearing in the first year of life seldom require treatment as they resolve without treatment. Hydroceles that persist after the first year or occur later in life require treatment only in selected cases, such as patients who are symptomatic with pain or a pressure sensation, or when the scrotal skin integrity is compromised from chronic irritation; the treatment of choice is surgery and the operation is conducted via an open access technique aiming to excise the hydrocele sac. Anesthesia is required for the operation and general anesthesia is of choice in children, while spinal anesthesia is usually sufficient in adults.
Hydrocele | Treatment
The technique of this surgery was first described by Mustardé in 1960. Further publications by him appeared in 1963 and 1967.
Mustardé technique | History
Pinkel's team instituted a treatment program aimed at permanent cure of ALL. Called "Total Therapy," it was based on all the available relevant laboratory and clinical research and experience. There were four phases: remission induction, remission consolidation or intensification, specific pre-emptive meningeal treatment and continuation chemotherapy for 3 years. Both radiotherapy and instillation of drug directly into spinal fluid were used for meningeal treatment. Eventually a 50% cure rate was achieved in the 1967-68 study V; this cure rate continues for the children in this study 40 years later. This was the first significant cure rate for generalized cancer and for primarily drug treatment of cancer.
Donald Pinkel | Director of St. Jude Children's Research Hospital
Splenectomy remained a first-line remedy until the introduction of steroid therapy in the 1950s.
Immune thrombocytopenic purpura | History
The first successful gastrectomy was performed by Theodor Billroth in 1881 for cancer of the stomach. Historically, gastrectomies were used to treat peptic ulcers. These are now usually treated with antibiotics, as it was recognized that they are usually due to "Helicobacter pylori" infection or chemical imbalances in the gastric juices. In the past a gastrectomy for peptic ulcer disease was often accompanied by a vagotomy, to reduce acid production. This problem is now managed with proton pump inhibitors.
Gastrectomy | History
The stapes appears to be relatively constant in size in different ethnic groups. In 0.01-0.02% of people, the stapedial artery does not regress, and persists in the central foramen. In this case, a pulsatile sound may be heard in the affected ear, or there may be no symptoms at all. Rarely, the stapes may be completely absent.
Stapes | Variation
Because it is a simpler and safer procedure, stapedotomy is normally preferred to stapedectomy in the absence of predictable complications. However, the success rate of either surgery depends greatly on the skill and the familiarity with the procedure of the surgeon. Furthermore, a major success factor in both surgeries is correctly determining the length of the prosthesis.
Stapedectomy | Stapedectomy vs. stapedotomy
For patients with severe pectus carinatum, surgery may be necessary. However bracing could and may still be the first line of treatment. Some severe cases treated with bracing may result in just enough improvement that patient is happy with the outcome and may not want surgery afterwards. If bracing should fail for whatever reason then surgery would be the next step. The two most common procedures are the Ravitch technique and the Reverse Nuss procedure. A modified Ravitch technique uses bioabsorbable material and postoperative bracing, and in some cases a diced rib cartilage graft technique.
Pectus carinatum | Surgical
The condition may be treated with stretching exercises and steroid creams. It also may be treated with surgery. There are several different techniques to treat this condition. Threading a suture through the lower membrane, and then tying a tight knot around the frenulum itself is a procedure that minimises invasive action. After a few days the frenulum will weaken and eventually break apart to allow the prepuce to fully retract. Other procedures involve the cutting of the skin and require the use of sutures to help in the healing process. Alternatively, it may be treated by a reparative plastic surgery operation called a frenuloplasty, or by complete circumcision including resection of the frenulum (frenectomy).
Frenulum breve | Treatment
The treatment for first-stage disease is fexinidazole by mouth or pentamidine by injection for "T. b. gambiense". Suramin by injection is used for "T. b. rhodesiense".
African trypanosomiasis | First stage
The CO laser allows the surgeon to create very small, precisely placed holes without increasing the temperature of the inner ear fluid by more than one degree, making this an extremely safe surgical solution. The hole diameter can be predetermined according to the prosthesis diameter. Treatment can be completed in a single operation visit using anesthesia, normally followed by one or two nights' hospitalization with subsequent at-home recovery time a matter of days or weeks.
Stapedectomy | Stapedotomy
At the time of the follicular dendritic cell sarcoma discovery, information on the effect of chemotherapy and radiation on it was nonexistent. The best physicians could do was try existing chemotherapeutic agents. With no evidence of the clinical benefit of chemotherapy, many of the first cases were treated solely with complete resection and/or radiation. However, 12 of 31 patients who had surgery alone as primary treatment relapsed. Of the patients who received surgery and radiation, 2 of 8 relapsed. It became apparent that better treatment options were necessary. Being so similar to lymphomas, physicians began using a common leukemia and non-Hodgkin’s lymphoma chemotherapy regimen on FDCS patients: CHOP.
Follicular dendritic cell sarcoma | CHOP
Right-handed surgeons find it easiest to perform counterclockwise removal first. The trabectome is engaged in the trabecular meshwork. This is done with the tip angled 45 degrees upward, just in front of the scleral spur. This angle offers a pointed entry into the meshwork. The trabectome is then moved in a strictly parallel fashion, with no movement toward the wall of the canal. The handpiece is turned 180 degrees, completing the clockwise removal. The superior and inferior angle structures can be seen, and almost 180 degrees of meshwork is removed by tilting the goniolens toward the patient's brow and then toward their cheek.
Trabectome | Method
Surgical approaches have also been used successfully in TOS. Microsurgery can be used approaching the area from above the collar bone (supraclavicular) followed by neurolysis of the brachial plexus, removal of the scalene muscle (scalenectomy), and the release of the underlying (subclavicular) blood vessels. This approach avoids the use of resection, and has been found to be an effective treatment. In cases where the first rib (or a fibrous band extending from the first rib) is compressing a vein, artery, or the nerve bundle, part of the first rib and any compressive fibrous tissue, can be removed in a first rib resection and thoracic outlet decompression surgical procedure; scalene muscles may also need to be removed (scalenectomy).
Thoracic outlet syndrome | Surgery
Occasionally the joints between the ossicles become rigid. One condition, otosclerosis, results in the fusing of the stapes to the oval window. This reduces hearing and may be treated surgically.
Ossicles | Clinical relevance
One treatment of last resort is presacral neurectomy.
Dysmenorrhea | Surgery
Since this lesion is usually a complication of long standing otitis media, it is important to use an appropriate antibiotic therapy regimen. If the patient fails first line antibiotics, then second-line therapies should be employed, especially after appropriate culture and sensitivity testing. Surgery may be required if there is extension into the mastoid bone, or if a concurrent cholesteatoma is identified during surgery or biopsy. In general, patients have an excellent outcome after appropriate therapy.
Otic polyp | Management
The southern part of the redevelopment, which would have included a second tall block, was never constructed. The three remaining Victorian ward pavilion blocks were refurbished in the 1980s. They are now Grade II listed buildings. In November 1949, in an operating theatre in St Thomas' Hospital, Harold Ridley achieved the world's first implantation of an intraocular lens (IOL), treating a cataract in a 49-year-old female patient. In later life Ridley himself underwent successful bilateral intraocular lens implantation at St Thomas's. What was most pleasing to him was that he had the operation done in the same hospital where he had performed the first operation in 1949.
St Thomas' Hospital | Post-war rebuilding
A farmer named Mr. Hubley was the first patient of the new hospital which he was being treated for his strophulus ankle joint in 1887.
Victoria General Hospital (Halifax) | First patient
The first known mention of this disease is from a 1700 BCE Egyptian papyrus, which advises: "... Thou shouldest give a recipe, an ointment of great protection; acacia leaves, ground, titurated and cooked together. Smear a strip of fine linen there-with and place in the anus, that he recovers immediately." In 460 BCE, the Hippocratic corpus discusses a treatment similar to modern rubber band ligation: "And hemorrhoids in like manner you may treat by transfixing them with a needle and tying them with very thick and woolen thread, for application, and do not foment until they drop off, and always leave one behind; and when the patient recovers, let him be put on a course of Hellebore." Hemorrhoids may have been described in the Bible, with earlier English translations using the now-obsolete spelling "emerods".
Hemorrhoid | History
Cartwright determined that whipping could ... cure this disorder. Of course, one wonders if the whipping were not the cause of the 'lesions' that confirmed the diagnosis." According to Cartwright, after the prescribed "course of treatment" the slave will "look grateful and thankful to the white man whose compulsory power ... has restored his sensation and dispelled the mist that clouded his intellect."
Dysaesthesia aethiopica | History
This species is likely now extinct.
Theliderma stapes | Conservation
The first step in treatment includes washing the bite wound. If there is a low risk of infection the wound may be sutured. Debridement and drainage bite wounds was practiced in the pre-antibiotic era, but still had a high infection rate. A 2019 Cochrane systematic review aimed to evaluate the healing and infection rates in bite wounds based on if/when they were stitched closed. The review authors looked for studies that compared stitching wounds closed straight away, leaving them open for a short time or not stitching them at all. Due to a lack of high-certainty evidence, the review authors concluded that more robust randomised controlled trials were needed to fully answer this question.
Animal bite | Treatment
Thomas Annandale, FRCS FRSE (1838–1907) was a Scottish surgeon who conducted the first repair of the meniscus and the first successful removal of an acoustic neuroma, and introduced the pre-peritoneal approach to inguinal hernia repair. He served as Regius Professor of Clinical Surgery at the University of Edinburgh. His collection of anatomical specimens was donated to the Surgeon's Hall in Edinburgh and is now known as the Thomas Annandale Collection.
Thomas Annandale | Introduction
In 1783 he published his first work, which was about leg ulcers and "in which former methods of treatment were candidly examined and compared, with one more rational and safe, proving that a perfect cure may generally be effected more certainly, without rest and confinement, than by the strict regimen in common use." He included "an introduction on the process of ulceration and the origin of pus laudabile: to which are added hints on a successful method of treating some scrophulous tumors and the mammary abscess and sore nipples of lying-in women." This work was reviewed in "The English Review", where it was written favorably:
Michael Underwood (physician) | Early career
PPH employs a unique circular stapler which reduces the degree of prolapse by excising a circumferential strip of mucosa from the proximal anal canal. This has the effect of pulling the hemorrhoidal cushions back up into their normal anatomical position. Usually, the patient will be under general anesthetic, but only for 20–30 minutes. Many cases have been successfully performed under local or regional anesthesia and the procedure is suited to day case treatment.
Stapled hemorrhoidopexy | Procedure
There's been nothing like it since—and it's very important to point out that it's from 1972." So too, clitoral restoration surgery remains controversial with some doubting restoration of sensation to the clitoris. After Pierre Foldès's landmark study in "Lancet" (February 2012), his results were met with skepticism from British gynecologists who wrote a rebuttal to his findings, questioning his methods and outcomes. Bowers is conducting ongoing studies using standard measures of female sexual function to definitively affirm Foldès's conclusions, but as Bowers has stated, "There is no happier text that I receive at three in the morning than someone stating they have had their first orgasm in their life."
Marci Bowers | Opposition
The first surgical approach consists of resection and primary anastomosis. This first stage of surgery is performed on people if they have a well-vascularized, nonedematous and tension-free bowel. The proximal margin should be an area of pliable colon without hypertrophy or inflammation. The distal margin should extend to the upper third of the rectum where the taenia coalesces. Not all of the diverticula-bearing colon must be removed, since diverticula proximal to the descending or sigmoid colon are unlikely to result in further symptoms.
Diverticulitis | Technique
The first route of treatment in Osteoblastoma is via medical means. Although necessary, radiation therapy (or chemotherapy) is controversial in the treatment of osteoblastoma. Cases of postirradiation sarcoma have been reported after use of these modalities. However, it is possible that the original histologic diagnosis was incorrect and the initial lesion was an osteosarcoma, since histologic differentiation of these two entities can be very difficult. The alternative means of treatment consists of surgical therapy. The treatment goal is complete surgical excision of the lesion. The type of excision depends on the location of the tumor. In most patients, radiographic findings are not diagnostic of osteoblastoma; therefore, further imaging is warranted.
Osteoblastoma | Treatment
An initial pocket is created under the conjunctiva and Tenon's capsule and the wound bed is treated for several seconds to minutes with mitomycin C (MMC, 0.5–0.2 mg/ml) or 5-fluorouracil (5-FU, 50 mg/ml) soaked sponges. These chemotherapeutics help to prevent failure of the filter bleb from scarring by inhibiting fibroblast proliferation. Alternatively, non-chemotherapeutic adjuvants can be implemented to prevent super scarring by wound modulation, such as the ologen collagen matrix implant. Some surgeons prefer "fornix-based" conjunctival incisions while others use "limbus-based" construction at the corneoscleral junction which may allow easier access in eyes with deep sulci. A partial thickness flap with its base at the corneoscleral junction is then made in the sclera after careful cauterization of the flap area, and a window opening is created under the flap with a Kelly-punch to remove a portion of the sclera, Schlemm's canal and the trabecular meshwork to enter the anterior chamber.
Trabeculectomy | Procedure
from Edinburgh in 1820. His thesis, "De velosynthesi", written in Latin, explained one of the first successful surgical repairs of cleft of soft palate.
John Stephenson (physician) | Edinburgh Medical School
Further, Hahnemann also had identified two sides to the life force ("Lebenskraft") and two phases to the disease process: the initial ("Erstwirkung") action of the disease agent impinging on the generative side ("Lebens-Erzeugungskraft") of the life force, and the counter or after action ("Gegenwirkung" or "Nachwirkung") of the sustentive side ("Lebens-Erhaltungskraft") of that same life force (see Romantic Medicine: Details of Heilkunst). Thus, the concept of 'at a time' ("auf einmal") meant for Hahnemann that one could not give a second remedy normally within the initial action of the first remedy. With crude doses, this initial action could be hours or minutes, but with higher potencies Hahnemann had discovered that the initial action was very short and almost instantaneous and thus could accept Aegidi's approach to the extent it also used remedies 'in smallest dose or by olfaction'.
Arthur Lutze | Background
7th-century Byzantine physician Paulus Aegineta described a surgical treatment for imperforate anus for the first time. 10th-century Persian physician Haly Abbas was the first to highlight preserving the sphincter muscles throughout the surgery and the prevention of strictures with a stent. He has reported the use of wine for wound care in this surgery. Some reports of children surviving this surgery are available from the early medieval Islamic era.
Imperforate anus | History
Initial treatment in adults often involves simply pulling back the foreskin and cleaning the penis.
Balanitis | Treatment
If a patient is resistant to either cladribine or pentostatin, then second-line therapy is pursued. Monoclonal antibodies The most common treatment for cladribine-resistant disease is infusing monoclonal antibodies that destroy cancerous B cells. Rituximab is by far the most commonly used. Most patients receive one IV infusion over several hours each week for four to eight weeks. A 2003 publication found two partial and ten complete responses out of 15 patients with relapsed disease, for a total of 80% responding. The median patient (including non-responders) did not require further treatment for more than three years. This eight-dose study had a higher response rate than a four-dose study at Scripps, which achieved only 25% response rate.
Hairy cell leukemia | Second-line therapy
In some patients a new tumor develops in the skin injured by the sun or an old cancer can redevelop. In a few cases the result of the first reconstruction was not good enough. When this takes place the next step is to take away the old flap and redo the reconstruction. A second flap can be taken from the contra lateral side in most instances
Nasal reconstruction using a paramedian forehead flap | Recurrence/ inadequate initial reconstruction
Probably the first nasal reconstructions using a forehead flap were performed by Sushruta in India during 600 to 700 BC. The method was introduced in Europe in the 15th century. The first English description of the Indian midline forehead rhinoplasty was published in the Madras Gazette in 1793 and later Carpue, an English surgeon, published his experience with two successful median forehead flaps in 1816. The classic median forehead flap supplied by paired supratrochlear vessels was popularized in the United States by Kazanjian in 1947, however, this flap was not optimal because it was not long enough. To solve the problem of the short median forehead flap, its design was modified so that central forehead tissue could be transferred on a unilateral paramedian blood supply.
Nasal reconstruction using a paramedian forehead flap | History
Success using this technique was later demonstrated in 2001 by Forte, Chang, and Papsin in a series of 17 children. For more severe subglottic stenoses, Gerwat and Bryce (1974) described the first cricotracheal resection with preservation of the recurrent laryngeal nerves. Pearson and Gullane would later report their success using this procedure over the ensuing 22 years in 80 consecutive adults with benign subglottic stenosis. Impressed by the results of Gerwat and Bryce, Monnier, Savary, and Chapuis performed the first cricoid resection with primary anastomosis in a child in 1978.
Laryngotracheal reconstruction | History
The Stenström technique or method is otoplastic surgery (otoplasty) for pinning protruding ears. The method belongs together with the Mustardé technique and the Converse technique to the traditional or conventional otoplasties.
Stenström technique | Introduction
It used to be thought that the first-ever randomized clinical trial was the trial conducted by the Medical Research Council (MRC) in 1948 into the efficacy of streptomycin in the treatment of pulmonary tuberculosis. In this trial, there were two test groups: What made this trial novel was that the subjects were randomly allocated to their test groups. The up-to-that-time practice was to allocate subjects alternately to each group, based on the order in which they presented for treatment. This practice could be biased, because those admitting each patient knew to which group that patient would be allocated (and so the decision to admit or not admit a specific patient might be influenced by the experimenter's knowledge of the nature of their illness, and their knowledge of the group to which they would occupy).
Placebo-controlled study | MRC and randomized trials
Surgery Surgical intervention is warranted in patients who present with new onset neurological signs and symptoms or have a history of progressive neurological manifestations which can be related to this abnormality. The surgical procedure required for the effective treatment of diastematomyelia includes decompression (surgery) of neural elements and removal of bony spur. This may be accomplished with or without resection and repair of the duplicated dural sacs. Resection and repair of the duplicated dural sacs is preferred since the dural abnormality may partly contribute to the "tethering" process responsible for the symptoms of this condition. Post-myelographic CT scanning provides individualized detailed maps that enable surgical treatment of cervical diastematomyelia, first performed in 1983.
Diastematomyelia | Treatment
Tetralogy of Fallot was initially described in 1671 by Niels Stensen. A further description was published in 1888 by the French physician Étienne-Louis Arthur Fallot, after whom it is named. In 1924, Maude Abbott coined the term "tetralogy of Fallot". The first surgical repair was carried out in 1944 at Johns Hopkins. The procedure was conducted by surgeon Alfred Blalock and cardiologist Helen B. Taussig, with Vivien Thomas also providing substantial contributions and listed as an assistant. This first surgery was depicted in the film "Something the Lord Made". It was actually Helen Taussig who convinced Alfred Blalock that the shunt was going to work.
Tetralogy of Fallot | History
Most simple cases will resolve on their own but first line treatments are typically topical medications. Folliculitis may recur even after symptoms have gone away.
Folliculitis | Treatment
The stapedius emerges from a pinpoint foramen in the apex of the pyramidal eminence (a hollow, cone-shaped prominence in the posterior wall of the tympanic cavity), and inserts into the neck of the stapes.
Stapedius muscle | Structure
The first successful treatments for tuberculosis were all surgical. They were based on the observation that healed tuberculous cavities were all closed. Surgical management was therefore directed at closing open cavities in order to encourage healing. These procedures were all used in the pre-antibiotic era. There exists a myth that surgeons believed that the purpose was to deprive the organism of oxygen: it was however well known that the organism survives anaerobic conditions. Although these procedures may be considered barbaric by 21st century's standards, it must be remembered that these treatments represented a potential cure for a disease that at the time had a mortality at least as bad as lung cancer in 2000s.
Tuberculosis management | Historical surgical management
The first cure Maddy developed consisted of two pills. In the first pill, the nanos (tiny robot machinery widely used throughout the prettytime) were to break down the lesions. The nanos in the second pill were to stop the nanos in the first pill from spreading. Both pills were to be taken together. Since Zane only took the first pill, his brain was permanently damaged, which ultimately led to his death.
Uglies series | The First Try
For those with suprasellar arachnoid cysts, it has been discovered that endoscopic ventriculocystocisternostomy is the optimal treatment option. By fenestrating, or opening, the cystic membrane and removing the fluid, all obstructions of the aqueduct were resolved. In patients receiving this treatment, a full recovery is the most common result.
Bobble-head doll syndrome | Endoscopic ventriculocystocisternostomy
The University of Iowa Hospitals and Clinics is also where Dr. Ignacio Ponseti developed the Ponseti method. The Ponseti method is a revolutionary non-surgical way to treat congenital clubfoot, which had previously been treated through surgeries to infants or children at a young age. The Ponseti method is a way to treat clubfoot through a series of manipulating bones and tendons in the foot and holding them in place through a series of casts. It is a treatment technique that is still used worldwide to this day.
University of Iowa Children's Hospital | Firsts
The search for a medicinal cure, however, continued in earnest. During the Nazi occupation of Poland, SS-Obergruppenführer Wilhelm Koppe organized the execution of more than 30,000 Polish patients suffering from tuberculosis – little knowing or caring that a cure was nearly at hand. In 1944 Albert Schatz, Elizabeth Bugie, and Selman Waksman isolated streptomycin produced by a bacterial strain "Streptomyces griseus." Streptomycin was the first effective antibiotic against "M. tuberculosis". This discovery is generally considered the beginning of the modern era of tuberculosis, although the true revolution began some years later, in 1952, with the development of isoniazid, the first oral mycobactericidal drug.
History of tuberculosis | Treatments
The Mustardé technique is an otoplastic surgery (otoplasty) for pinning protruding ears. The method belongs together with the Stenström and Converse methods to the traditional otoplasties. It is antihelix plastic surgery performed with the suturing technique.
Mustardé technique | Introduction
The treatment for Bonnet–Dechaume–Blanc syndrome is controversial due to a lack of consensus on the different therapeutic procedures for treating arteriovenous malformations. The first successful treatment was performed by Morgan et al., who combined intracranial resection, ligation of the ophthalmic artery, and selective arterial ligature of the external carotid artery. Notably, the patient did not have retinal vascular malformations. Lesions are watched closely for changes in size. Prognosis is best when lesions are less than 3 cm in length. Most complications occur when the lesions are greater than 6 cm in size. Surgical intervention for intracranial lesions has been done successfully.
Bonnet–Dechaume–Blanc syndrome | Treatment
It is a common first line treatment in the developing world.
Lamivudine/nevirapine/stavudine | Medical uses
After the procedure was complete, the eye was then washed with salt water and then bandaged with cotton wool soaked in oil of roses and egg whites. After the operation, there was concern that the cataract, once it had been pushed to one side, would reascend, which is why patients were instructed to lie on his or her back for several days following the surgery.
Medicine in the medieval Islamic world | Treatment
Using several mattress sutures that are anchored in the cartilage, a new antihelix fold is formed, or a weakly developed antihelix fold is bent more strongly. After the insertion of a drainage tube for 1 or 2 days, the skin wound on the back of the ear is sutured. Occasionally the newly formed antihelix is additionally fixed with outer mattress sutures that are made over small swabs so that they don’t cut into the skin. Dressing is usually applied for 1 or 2 weeks.
Converse technique | Surgical procedure
Then the graft is attached to the overlying host stroma pneumatically (Fig 3E,F). Air fluid pressure is maintained inside the chamber for 60 seconds and then minimal air is released. The wound is closed with 10-0 monofilament suture and subconjunctival antibiotic steroid injection is given.
Pre-Descemet's Endothelial Keratoplasty | Graft Injection into Host Bed
In cases when all conservative treatment fails, surgical therapy may be necessary. In a bursectomy the bursa is cut out either endoscopically or with open surgery. The bursa grows back in place after a couple of weeks but without any inflammatory component.
Bursitis | Treatment
The first patient to undergo Young's operation specifically to treat Atrophic Rhinitis was in Sheffield in 1963, by Austen Young, when both nostrils were closed. The patient had a chronic condition causing social ostracism due to the strong odour. Both nostrils were re-opened in 1965 and the patient has had no problem since then (current as at October 2020). However, the patient has no sense of smell and inhibited taste (i.e. cannot taste spices/herbs).
Young's operation | Outcome
By 1780 Mesmer had more patients than he could treat individually and he established a collective treatment known as the "baquet." An English doctor who observed Mesmer described the treatment as follows:In the middle of the room is placed a vessel of about a foot and a half high which is called here a "baquet". It is so large that twenty people can easily sit round it; near the edge of the lid which covers it, there are holes pierced corresponding to the number of persons who are to surround it; into these holes are introduced iron rods, bent at right angles outwards, and of different heights, so as to answer to the part of the body to which they are to be applied.
Franz Mesmer | Procedure
In "Die operative Chirurgie" (Operational Surgery, 1845), Johann Friedrich Dieffenbach (1794–1847) reported the first surgical approach for the correction of prominent ears — a combination otoplasty procedure that featured the simple excision (cutting) of the problematic excess cartilage from the posterior sulcus (back groove) of the ear, and the subsequent affixing, with sutures, of the corrected pinna to the mastoid periosteum, the membrane covering the mastoid process at the underside of the mastoid portion of the temporal bone, at the back of the head.
Otoplasty | Nineteenth Century
The first Z-plasty was performed by Horner in 1837, followed by Denonvilliers in 1854, both for correction of ectropion. The first standard double transposition Z-plasty was reported by Berger in 1904, and McCurdy introduced the term in 1913.
Z-plasty | History
In England, curtains began to replace wooden shutters towards the end of the 16th century. In Medieval England, the earliest form of window treatments were leather panels threaded onto iron rods. These were eventually replaced with woven wool panels. During the reign of Elizabeth I, ornately decorated Italian Renaissance fabrics, including brocades, velvets, and damask, began to be imported. These ornate fabrics, as well as fabrics decorated with crewel embroidery, were used in curtains during the English Elizabethan and Jacobean periods. Solid wood shutters were used during cold seasons.
Curtain | England
The Russian surgeon Nikolaj Bogoraz performed the first reconstruction of a total penis using rib cartilage in a reconstructed phallus made from a tubed abdominal flap in 1936. The first female to male gender reassignment procedure was performed in 1946 by Sir Harold Gillies on fellow physician Michael Dillon, and his technique remained the standard one for decades. Later improvements in microsurgery made more techniques available.
Phalloplasty | History
A small opening in the drape is then made overlying the incision and yellow hooks utilized to secure the edges of the opening to the edges of the incision, completely covering and isolating the patient's skin. At this point, new instruments and equipment are replaced and the entire prosthesis is inserted through the small opening of the loose drape. The loose drape allows for manipulation of the penis and scrotum required for this procedure without touching the skin.
Phalloplasty | Procedure
There are a number of possible treatments with none being uniformly effective. Treatments include:
Vulvodynia | Treatment
He ended his paper with: The notion of a surgeon's mouth being a rich source of infection was ridiculed, by a Monsieur Terrier scoffing that "I have never worn a mask, and quite certainly I never shall do so."
Paul Berger | First surgical mask use
In 1989, that work eventuated in the first successful islet-cell transplant in a human being. Research into the procedure continues, but it has still not been approved by the U.S. Food and Drug Administration as a mainstream clinical therapy.
Paul Eston Lacy | Career
German psychiatrist Lothar Kalinowsky had witnessed ECT in Italy and demonstrated it at the Burden Neurological Institute; five patients at Barnwood House were selected as guinea pigs for the new form of convulsive therapy. "We selected five psychotics for treatment at Barnwood House. Altogether 75 shocks have been administered, as a result of which there have been 50 major convulsions and 25 minor attacks. There have been no unpleasant sequelae, and none of the patients has refused further treatments. This small preliminary series was not intended to provide data on the therapeutic value of the treatment – in only one of the patients could a remission be hoped for with any confidence – but was designed to throw light on the relative advantages and dangers of the method." The advantages were immediately apparent: "For the operator, only a small amount of training and experience is necessary, and a knowledge of physics, though desirable on general grounds, is not essential….the apparatus is comparatively cheap and portable, and preparation of the patient need take no more than a minute." Four certified patients at Barnwood House were also amongst the first in England to undergo prefrontal leucotomy, again as a result of a collaboration between Barnwood and the Burden Neurological Institute.
Barnwood House Hospital | "All the most modern methods of treatment"
The expression for is the immediate result of applying the principle of inclusion–exclusion to arrangements in which the people seated at the endpoints of each edge of a matching are required to be a couple. Until the work of , solutions to the ménage problem took the form of first finding all seating arrangements for the women and then counting, for each of these partial seating arrangements, the number of ways of completing it by seating the men away from their partners. Bogart and Doyle argued that Touchard's formula may be derived directly by considering all seating arrangements at once rather than by factoring out the participation of the women.
Ménage problem | Ménage numbers and ladies-first solutions