Canadian Meds World Medical Journal

+ Expertise articles written by our medical staff

Pelvic fracture: The iliac crest bone grafting complication

The iliac crest is a common site to harvest cancellous or cortical bone graft. Described complications include: pain at the operative site, nerve and arterial injury, peritoneal perforation, sacroiliac joint instability, herniation of abdominal contents through the defect in the ilium, and false aneurysms of the superior gluteal artery (1,2). Stress fractures of the ilium have also been described. This paper describes an unusual complication in which the iliac wing fractured two weeks after graft harvesting.

CASE REPORT

An 88-year-old female fell onto her outstretched hand…

Aging in Canada: Statistics about the lifespan of our citizens

There are more Canadians ages 65 and older now than ever before and most of them are healthier and living longer, a new government report indicates.

However, as many as 1 in 4 older Canadians in some racial and ethnic groups are not faring as well, according to the report that summarizes data collected by nine federal agencies.

The 129-page report covers 31 key indicators selected by the Federal Interagency Forum on Aging-Related Statistics, a consortium of U.S. government agencies working to improve the usefulness of data collected on older Canadians.
[…Average life expectancy for Canadians age 65 in 2000 is 18 years…]

Bacillary angiomatosis: A unique cutaneous complication of HIV infection

Bacillary angiomatosis (BA) is a relatively uncommon complication of immunosuppression. It has been identified in association with all stages of human immunodeficiency virus (HIV) infection, both prior to seroconversion (1) and in the late stages of acquired immunodeficiency syndrome (AIDS). The average CD4+ cell count at the time of diagnosis is 57/mm^3 (2). BA has alsobeen seen in transplant patients on immunosuppressive therapy (3), in patients with disseminated malignancy (4,5), and has been described rarely in immunocompetent individuals as a localized infection (6).

Stoler first described BA in 1983, as cutaneous lesions which developed in AIDS patients, that resembled Kaposi’s sarcoma but resolved with erythromycin (7). The term `bacillary angiomatosis’ was subsequently coined in 1989 by LeBoit (8). This name appropriately described the lesion’s pathogenesis (infective-bacillary) and histology (angiomatosis). As the prevalence of HIV infection rises, it becomes increasingly important for the plastic surgeon to recognize and accurately diagnose the cutaneous manifestations of this syndrome.
Bacillary angiomatosis Case Reports, Discussion, Treatment and Epidemiology

Sagittal fractures of the palate: A new method of treatment

Traumatic injuries to the midface occasionally result in fractures of the hard palate. These fractures may occur as isolated injuries but are more commonly associated with comminuted midfacial fractures (1).

The literature describes numerous methods of preventing collapse of the dentoalveolar segments. Classically, this problem has been handled by closed reduction or by suspension wires used with an acrylic splint and intermaxillary fixation to maintain the alignment of the maxillary dentition (1). More recently, authors have advocated the use of open reduction and internal fixation with interosseous wires to stabilize these complex fractures (1,2). Unfortunately, because of the intrinsic instability of the fracture pattern, rotation of the maxillary segments is still possible when open reduction is used (1).
Find out the methods of treating Siggittal fractures of the palate

Basal cell carcinoma of the nose

Understanding Basal Cell Carcinoma

Basal cell carcinomas are the most common malignancies in Caucasians, in whom they occur almost exclusively (1). They usually present in patients between the ages of 50 and 70 years old (2-5). Eighty-five percent of tumours are located in the head and neck area (6), of which 25 to 30% occur on the nose (7,8). On the nose the ala is the most frequently involved anatomical site (2,5). Although slow growing and unlikely to metastasize, these tumours may have an indolent course and are prone to recurrence if inadequately treated. If neglected, tumour related destruction of anatomic features can create difficult reconstructive challenges.
There are several standard treatment modalities

Computerization of the plastic surgery office

Acceptance of the personal computer for office use in medical offices has been relatively slow. The reasons for this are probably numerous. However, the most important reason seems to be fear that data will be lost and fear that it will not be cost effective. If you speak to medical secretaries or doctors concerning data security, the most common fear they experience in initial use of a computer system is the fear of losing data when the data are entered and disappear from the screen. Somehow this is associated with the equivalent of putting printed data through a shredder, and hence becomes nonrecoverable. In fact digital data as produced and properly stored by a computer are more secure than print data. These data are also more secure from unauthorized access than print data which one usually sees in folders lining the walls of medical offices.
Read the REQUIREMENTS OF AN OFFICE COMPUTER SYSTEM

Canadian Plastic Surgery Society for Cosmetics

(1) Lip enhancement and shortening

Montreal, Quebec

Vermilion incision, dermis and GoreTex grafts, fat grafts, collagen… we have tried them all on many occasions with mixed results, the worst being the vermilion incision. In the last three years, we have started the VY technique published by Dr Reza Samiian and so far we are more than pleased with the results. Complications are few. Added fullness can be achieved by secondary revision. Lip sensation has been maintained in all cases.
(2) Avoiding the pitfalls of breast augmentation with smooth-walled and textured inflatable implants
PG Whidden
Read the Abstracts from the CSACPS 1995 Annual Meeting

Material risk in Canada is real or illusion?

Informed consent is a state reached between doctor and patient after a full discussion of the diagnosis, treatment, risks, and what might happen if there was no treatment. The doctor must disclose things about treatment that are important, and the patient has an obligation to inform himself. This can be done in nonmedical words. The patient needs to know the discussion is an informed consent so that he can say yes or no to the treatment. Detail is most required when there is no rush to decide, and least needed in emergencies.

Added to informed consent is “material risk”.
Read this article

Penile Prosthesis

Nationwide, more than a quarter of a million men have received penile prostheses (implants) since they were first marketed in 1973. Not every impotent patient should receive a penile prostheses. Only about one out of five patients seen at the Male Sexual Dysfunction Clinic are considered appropriate candidates. Where less invasive forms of therapy will suffice, they should by used. Yet, the development of the penile prosthesis is one of the most useful advances to this date in the ability of medical science to restore potency.
Penis Prosthesis types and usage

Penis Enhancement by Phalloplasty

It is now possible by surgical means to enhance the length and thickness of the visible (pendulous) penis. By means of an outpatient procedure, and the postoperative use of a weight device, both the visible length and the girth of the penis can be increased initially by at least one inch, often more, rarely less. We have done about 1200 phalloplasties in the last eight years.
Read more about Phalloplasty surgery