Surgical Home Research Articles

Improved Outcome in Pierre Robin Sequence: Effect of Multidisciplinary Evaluation and Management

Infants with complications of Pierre Robin sequence are at increased risk of airway obstruction and resultant hypoxia, cor pulmonale, failure to thrive, and cerebral impairment. In an effort to minimize such complications, patients with Pierre Robin sequence were examined prospectively by a multidisciplinary team using polysomnography and continuous oximetry. Obstructive apnea and desaturation occurred in 18 of the 21 patients studied. Four children required only home apnea monitoring, and six required only monitoring and supplemental oxygen. Seven children had lip-tongue adhesion procedures performed, and four required tracheostomy. No patients died. All patients with isolated Pierre Robin sequence had normal development at follow-up except for one child who had experienced a respiratory arrest before referral. With improvements in neonatal intensive care, testing for respiratory assessment, improved surgical and postoperative intervention and home monitoring, the morbidity and mortality for children with Pierre Robin sequence can be reduced markedly.

Vaginal Amplification Using a Posterolateral Y-V Plasty

Problems encountered in attempts to construct a normal vaginal orifice in girls with congenital adrenal hyperplasia have met with great difficulty. Many procedures are complicated by failure to achieve adequate patency at the time of operation and/or by postoperative stenosis. The usual method of direct posterior Y-V vaginoplasty has been altered by bringing the V flap in from the side of the perineum, between the inferior aspect of the labium majus and the median perineal raphe. Thereby, a thicker, larger, more pliable and more movable flap is obtained. The 11 children on whom this method was done are presented. Followup is from 6 months to 5½ years. The importance of teaching the parents or child the use of home vaginal dilation with Hegar dilators is stressed. The use of this surgical technique plus home dilation will overcome the problems of restenosis in this group of children.

A surgical follow-up and home visit program.

A surgical follow-up program has been organized on new lines. Over 2,000 patients have been observed. Two and one-half years of experience reveal an ability to follow up 90% of the patients leaving the hospital. A monthly newsletter has been circulated; a home visiting program has grown as an offspring. The program has promoted continuity of patient care, improved education of students and house staff, and has pointed to the needs of continued comprehensive patient care in the future. It further has made readily available data for specific follow-up information on certain surgical diseases. A 73% ambulation rate six months or later for patients treated for fractures of the hip by operation is cited as an example of the information derived.

The Lunacy Commissioners and the Surgical Home for Women

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The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The Lunacy Commissioners and the Surgical Home for Women

The London Surgical Home

The London Surgical Home

Cases of Ovariotomy at the London Surgical Home

Cases of Ovariotomy at the London Surgical Home